Skip to main content
SpringerLink
Log in

Der Rezidivtumor

Tumour recurrence

  • Leitthema
  • Published:
Der Urologe Aims and scope Submit manuscript

Zusammenfassung

Die S3-Leitlinie behandelt im Kap. 6 ausführlich das Tumorrezidiv nach kurativ intendierter Lokaltherapie, also radikaler Prostatektomie oder einer Form der Strahlentherapie. Das PSA-Rezidiv nach Operation wird ab 0,2 ng/ml definiert, das nach Strahlentherapie als Anstieg über den Nadir von mindestens 2 ng/ml. Faktoren für die klinische Bewertung, dass ausschließlich ein Lokalrezidiv vorliegt, sind empirische Indikatoren der primären Tumordiagnose und des zeitlichen PSA-Verlaufs nach Primärtherapie. Eine Salvagebestrahlung nach Operation sollte ohne histologische Sicherung des Lokalrezidivs und bei Vorliegen günstiger empirischer Indikatoren möglichst frühzeitig (PSA<0,5 ng/ml) erfolgen. Vor einer Salvageoperation mit höherer Komplikationsrate sollte das Lokalrezidiv histologisch gesichert werden.

Abstract

In Chap. 6 the German S3 guideline on prostate cancer addresses the issue of tumour recurrence following primary local treatment with curative intent, i.e. after radical prostatectomy or a form of radiotherapy. PSA recurrence after radical surgery is defined as a rising PSA of 0.2 ng/ml and after radiotherapy as an increase of at least 2 ng/ml above the individual nadir. Factors for the clinical judgement that a local recurrence is likely are empirical indicators from the primary tumour diagnosis and the PSA course after primary treatment. Salvage external beam radiotherapy after radical surgery does not require the histological proof of a local recurrence and should be initiated early (PSA < 0.5 ng/ml). Before salvage radical prostatectomy, which carries a higher complication rate, the presence of a local recurrence should be histologically verified.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

  1. Stephenson AJ, Kattan MW, Eastham JA et al (2006) Defining biochemical recurrence of prostate cancer after radical prostatectomy: a proposal for a standardized definition. J Clin Oncol 24(24):3973–3978

    Article  CAS  PubMed  Google Scholar 

  2. Freedland SJ, Sutter ME, Dorey F, Aronson WJ (2003) Defining the ideal cutpoint for determining PSA recurrence after radical prostatectomy. Prostate-specific antigen. Urology 61(2):365–369

    Article  PubMed  Google Scholar 

  3. Roach M 3rd, Hanks G, Thames H Jr et al (2006) Defining biochemical failure following radiotherapy with or without hormonal therapy in men with clinically localized prostate cancer: recommendations of the RTOG-ASTRO Phoenix consensus conference. Int J Radiat Oncol Biol Phys 65(4):965–974

    PubMed  Google Scholar 

  4. Heidenreich A, Aus G, Abbou CC et al (2007) European association of urology. EAU guidelines on prostate cancer. EAU, Arnhem

  5. Foster LS, Jajodia P, Fournier G Jr et al (1993) The value of prostate specific antigen and transrectal ultrasound guided biopsy in detecting prostatic fossa recurrences following radical prostatectomy. J Urol 149(5):1024–1028

    CAS  PubMed  Google Scholar 

  6. Fitch DL, McGrath S, Martinez AA et al (2006) Unification of a common biochemical failure definition for prostate cancer treated with brachytherapy or external beam radiotherapy with or without androgen deprivation. Int J Radiat Oncol Biol Phys 66(5):1430–1439

    CAS  PubMed  Google Scholar 

  7. Buyyounouski MK, Hanlon AL, Eisenberg DF et al (2005) Defining biochemical failure after radiotherapy with and without androgen deprivation for prostate cancer. Int J Radiat Oncol Biol Phys 63(5):1455–1462

    Article  PubMed  Google Scholar 

  8. Denham JW, Kumar M, Gleeson PS et al (2009) Recognizing false biochemical failure calls after radiation with or without neo-adjuvant androgen deprivation for prostate cancer. Int J Radiat Oncol Biol Phys 74(2):404–411

    PubMed  Google Scholar 

  9. Crook J, Malone S, Perry G et al (2000) Postradiotherapy prostate biopsies: what do they really mean? Results for 498 patients. Int J Radiat Oncol Biol Phys 48(2):355–367

    CAS  PubMed  Google Scholar 

  10. Fowler JE Jr, Brooks J, Pandey P, Seaver LE (1995) Variable histology of anastomotic biopsies with detectable prostate specific antigen after radical prostatectomy. J Urol 153(3 Pt 2):1011–1014

    Article  PubMed  Google Scholar 

  11. Heidenreich A, Bolla M, Joniau S et al (2009) EAU guidelines on prostate cancer. EAU, Arnhem

  12. Bader P, Burkhard FC, Markwalder R, Studer UE (2003) Disease progression and survival of patients with positive lymph nodes after radical prostatectomy. Is there a chance of cure? J Urol 169(3):849–854

    Article  PubMed  Google Scholar 

  13. Gomez P, Manoharan M, Kim SS, Soloway MS (2004) Radionuclide bone scintigraphy in patients with biochemical recurrence after radical prostatectomy: when is it indicated? BJU Int 94(3):299–302

    Article  PubMed  Google Scholar 

  14. Horwitz EM, Thames HD, Kuban DA et al (2005) Definitions of biochemical failure that best predict clinical failure in patients with prostate cancer treated with external beam radiation alone: a multi-institutional pooled analysis. J Urol 173(3):797–802

    Article  PubMed  Google Scholar 

  15. Freedland SJ, Humphreys EB, Mangold LA et al (2005) Risk of prostate cancer-specific mortality following biochemical recurrence after radical prostatectomy. JAMA 294(4):433–439

    Article  CAS  PubMed  Google Scholar 

  16. Ganswindt U, Stenzl A, Bamberg M, Belka C (2008) Adjuvant radiotherapy for patients with locally advanced prostate cancer-a new standard? Eur Urol 54(3):528–542

    Article  PubMed  Google Scholar 

  17. Loeb S, Roehl KA, Viprakasit DP, Catalona WJ (2008) Long-term rates of undetectable PSA with initial observation and delayed salvage radiotherapy after radical prostatectomy. Eur Urol 54(1):88–94

    Article  PubMed  Google Scholar 

  18. Morris MM, Dallow KC, Zietman AL et al (1997) Adjuvant and salvage irradiation following radical prostatectomy for prostate cancer. Int J Radiat Oncol Biol Phys 38(4):731–736

    Article  CAS  PubMed  Google Scholar 

  19. Leonardo C, Simone G, Papalia R et al (2009) Salvage radical prostatectomy for recurrent prostate cancer after radiation therapy. Int J Urol 16(6):584–586

    Article  PubMed  Google Scholar 

  20. Thompson IM Jr, Tangen CM, Paradelo J et al (2006) Adjuvant radiotherapy for pathologically advanced prostate cancer: a randomized clinical trial. JAMA 296(19):2329–2335

    Article  CAS  PubMed  Google Scholar 

  21. Catton C, Gospodarowicz M, Warde P et al (2001) Adjuvant and salvage radiation therapy after radical prostatectomy for adenocarcinoma of the prostate. Radiother Oncol 59(1):51–60

    Article  CAS  PubMed  Google Scholar 

  22. Jereczek-Fossa BA, Orecchia R (2007) Evidence-based radiation oncology: Definitive, adjuvant and salvage radiotherapy for non-metastatic prostate cancer. Radiother Oncol 84(2):197–215

    Article  PubMed  Google Scholar 

  23. Zelefsky MJ, Aschkenasy E, Kelsen S, Leibel SA (1997) Tolerance and early outcome results of postprostatectomy three-dimensional conformal radiotherapy. Int J Radiat Oncol Biol Phys 39(2):327–333

    CAS  PubMed  Google Scholar 

  24. Coetzee LJ, Hars V, Paulson DF (1996) Postoperative prostate-specific antigen as a prognostic indicator in patients with margin-positive prostate cancer, undergoing adjuvant radiotherapy after radical prostatectomy. Urology 47(2):232–235

    Article  CAS  PubMed  Google Scholar 

  25. Garg MK, Tekyi-Mensah S, Bolton S et al (1998) Impact of postprostatectomy prostate-specific antigen nadir on outcomes following salvage radiotherapy. Urology 51(6):998–1002

    Article  CAS  PubMed  Google Scholar 

  26. Heidenreich A, Richter S, Thuer D, Pfister D (2009) Prognostic parameters, complications, and oncologic and functional outcome of salvage radical prostatectomy for locally recurrent prostate cancer after 21st-century radiotherapy. Eur Urol 55:1251–1265

    Article  PubMed  Google Scholar 

  27. Trock BJ, Han M, Freedland SJ et al (2008) Prostate cancer-specific survival following salvage radiotherapy vs observation in men with biochemical recurrence after radical prostatectomy. JAMA 299(23):2760–2769

    Article  CAS  PubMed  Google Scholar 

  28. Jereczek-Fossa BA, Zerini D, Vavassori A et al (2009) Sooner or later? Outcome analysis of 431 prostate cancer patients treated with postoperative or salvage radiotherapy. Int J Radiat Oncol Biol Phys 74(1):115–125

    PubMed  Google Scholar 

  29. Murat FJ, Poissonnier L, Rabilloud M et al (2008) Mid-term results demonstrate salvage high-intensity focused ultrasound (HIFU) as an effective and acceptably morbid salvage treatment option for locally radiorecurrent prostate cancer. Eur Urol 53(3):547–553

    Article  Google Scholar 

  30. Nguyen PL, D’Amico AV, Lee AK, Suh WW (2007) Patient selection, cancer control, and complications after salvage local therapy for postradiation prostate-specific antigen failure: a systematic review of the literature. Cancer 110(7):1417–1428

    Article  PubMed  Google Scholar 

  31. Heidenreich A, Semrau R, Thuer D, Pfister D (2008) Die radikale Salvageprostatektomie: Therapie des lokalen Prostatakarzinomrezidivs nach Strahlentherapie. Urologe A 47(11):1441–1446

    Article  CAS  PubMed  Google Scholar 

  32. Bianco FJ Jr, Scardino PT, Stephenson AJ et al (2005) Long-term oncologic results of salvage radical prostatectomy for locally recurrent prostate cancer after radiotherapy. Int J Radiat Oncol Biol Phys 62(2):448–453

    PubMed  Google Scholar 

  33. Scardino PT (1983) The prognostic significance of biopsies after radiotherapy for prostatic cancer. Semin Urol 1(4):243–252

    CAS  PubMed  Google Scholar 

  34. Scattoni V, Picchio M, Suardi N et al (2007) Detection of lymph-node metastases with integrated [11C]choline PET/CT in patients with PSA failure after radical retropubic prostatectomy: results confirmed by open pelvic-retroperitoneal lymphadenectomy. Eur Urol 52(2):423–429

    Article  PubMed  Google Scholar 

  35. Goluboff ET, Prager D, Rukstalis D et al (2001) Safety and efficacy of exisulind for treatment of recurrent prostate cancer after radical prostatectomy. J Urol 166(3):882–886

    Article  CAS  PubMed  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Urologische Universitäts-Klinik und Poliklinik, Ernst-Heydemann-Straße 6, 18055, Rostock, Deutschland

    O.W. Hakenberg

  2. Universitätsklinik für Radiotherapie und Radio-Onkologie, Salzburg, Österreich

    F. Sedlmayer

Authors
  1. O.W. Hakenberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. F. Sedlmayer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to O.W. Hakenberg.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hakenberg, O., Sedlmayer, F. Der Rezidivtumor. Urologe 49, 228–232 (2010). https://doi.org/10.1007/s00120-010-2239-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00120-010-2239-2

Schlüsselwörter

Keywords

Search

Navigation