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Organbegrenztes Prostatakarzinom mit positivem Resektionsrand

Stellenwert der adjuvanten Radiatio

Organ-limited prostate cancer with positive resection margins

Importance of adjuvant radiation therapy

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Zusammenfassung

Beim pT3-Prostatakarzinom mit positivem Resektionsrand ist der Stellenwert der postoperativen Strahlentherapie durch eine hohe Evidenzlage belegt. In der pT2 R1-Situation stehen prospektiv randomisierte Studien bezüglich dieser Frage jedoch derzeit noch aus. Trotz besserer lokaler Tumorkontrolle im pT2-Stadium liegt die PSA-Rezidivrate zwischen 25 und 40% und der positive Absetzungsrand ist ein unabhängiger Faktor für ein Rezidiv. Retrospektive Studien suggerieren den positiven Effekt einer adjuvanten oder Salvageradiatio für das onkologische Outcome in der pT2 R1-Situation. Andererseits ist trotz moderner Bestrahlungstechnik das Nebenwirkungsprofil mit potentiell negativer Beeinflussung der postoperativen Kontinenzerlangung und diverser Spättoxizitäten nicht unerheblich und sollte im Zeitalter ultrasensitiver PSA-Analysen in der Risiko-Nutzen-Abwägung Beachtung finden. Solange der optimale Beginn der postoperativen Strahlentherapie ungeklärt ist, sollte die Indikationsstellung zu einer adjuvanten oder Salvageradiatio beim organbegrenzten Prostatakarzinom mit positivem Resektionsrand nach einer individuellen Patientenberatung und unter Berücksichtigung der Rezidivrisikofaktoren wie des Gleason-Grades, der Lokalisation und Ausdehnung des Resektionsrandes erfolgen.

Abstract

For pT3 prostate cancer with positive resection margins, the importance of postoperative radiation therapy is confirmed by a high level of evidence. However, for the pT2,R1 situation prospective, randomized studies concerning this question are lacking. Despite better local tumor control in the pT2 stage the PSA recurrence rate lies between 25% and 40% and positive margins are an independent factor for recurrence. Retrospective studies suggest a positive effect of adjuvant or salvage radiation for the oncological outcome in the pT2,R1 situation. On the other hand the side effects profile, with a potentially negative influence of postoperative continence and various delayed toxicities, is not insignificant despite modern radiation techniques and in the era of ultrasensitive PSA analysis should be considered in the risk-benefit assessment. As long as the optimal initiation of postoperative radiation therapy is unclear, the assessment of indications for adjuvant or salvage radiation for organ-limited prostate cancer with positive resection margins should be made after an individual patient consultation and under consideration of the recurrence risk factors, such as the Gleason grade and the localization and extent of the resection margins.

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Porres, D., Pfister, D., Brehmer, B. et al. Organbegrenztes Prostatakarzinom mit positivem Resektionsrand. Urologe 51, 1246–1252 (2012). https://doi.org/10.1007/s00120-012-2871-0

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