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Aktuelle Entwicklungen in der Diagnostik und Therapie des Harnblasenkarzinoms

Current developments in the diagnostics and therapy of bladder carcinoma

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Zusammenfassung

In nahezu allen klinischen Fragestellungen beim Harnblasenkarzinom hat es in den letzten 12 Monaten Fortschritte gegeben. Die Früherkennung mittels Urintests ist jedoch weiterhin schwierig, so dass keiner der zur Verfügung stehenden Urintests als Screeninguntersuchung in der Normalbevölkerung empfohlen werden kann. Die photodynamische Diagnostik und Resektion scheint einen Einfluss auf das rezidivfreie Überleben der Patienten zu haben. Beim pT1G3-Tumor mehren sich die Hinweise, dass eine frühe Zystektomie den organerhaltenden Therapiekonzepten im Hinblick auf die Prognose der Patienten überlegen ist. Bei der perioperativen Chemotherapie ist der Nutzen der adjuvanten Chemotherapie kaum mehr von der Hand zu weisen, nachdem neben zahlreichen retrospektiven Daten auch in randomisierten Phase-III-Studien deutliche Überlebensvorteile gezeigt werden können. Darüber hinaus wird auch beim Harnblasenkarzinom die molekulare Diagnostik für die Chemotherapie in Zukunft eine Rolle spielen, um geeignete Patienten für eine systemische Chemotherapie zu identifizieren.

Abstract

Considerable progress has been made in nearly all clinical scenarios of bladder carcinoma. Nevertheless early detection of bladder carcinoma using urine markers is still difficult so that none of the available tests can be recommended as a screening test. Photodynamic diagnostics and resection has now been shown for the first time to improve recurrence-free survival of patients but this impact on survival has to be confirmed in a phase III clinical trial before being regarded as standard of care. In pT1G3 tumors early cystectomy seems to improve the prognosis compared to organ preserving strategies. The value of adjuvant chemotherapy is becoming more and more evident, as, apart from several retrospective analyses it has been shown to improve survival in a clinical phase III trial. Furthermore, molecular markers are gaining importance and in the future can be used for identifying patients who may benefit from systemic chemotherapy of bladder carcinoma.

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  1. Klinik für Urologie und Kinderurologie, Universitätsklinikum des Saarlandes, Kirrbergerstraße 1, Gebäude 6, 66421, Homburg/Saar, Deutschland

    J. Kamradt, C.-H. Ohlmann & M. Stöckle

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  1. J. Kamradt
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  2. C.-H. Ohlmann
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  3. M. Stöckle
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Correspondence to C.-H. Ohlmann.

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Kamradt, J., Ohlmann, CH. & Stöckle, M. Aktuelle Entwicklungen in der Diagnostik und Therapie des Harnblasenkarzinoms. Urologe 50 (Suppl 1), 179 (2011). https://doi.org/10.1007/s00120-011-2682-8

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