Zusammenfassung
Hintergrund
Patienten mit Low-risk-Prostatakarzinom (PCa) stehen im Zwiespalt zwischen potentieller Übertherapie durch eines der Standardtherapieverfahren und fraglicher Unsicherheit hinsichtlich der Tumorkontrolle der „Active Surveillance“ (AS). Eine „fokale Therapie“ (FT) bedeutet die Behandlung nur des tumortragenden Prostatateils.
Methoden
Diese Arbeit bewertet die vorliegende Evidenz verschiedener Techniken zur FT sowie Konzepten zur Diagnostik, Lokalisation und histologischen Beurteilung.
Ergebnisse
Wenige, unizentrische, retrospektive Daten zur Effektivität der FT bei PCa deuten an, dass bei kurzem Follow-up eine zufriedenstellende Tumorkontrolle bei günstigem Nebenwirkungsprofil zu erreichen ist. Es bestehen Schwächen in der Tumordetektion sowie der histologischen Beurteilung. Multizentrische Studien mit größeren Fallzahlen rekrutieren aktuell Patienten und werden Daten mit höherem Evidenzlevel liefern.
Schlussfolgerung
Derzeit sollte die FT nicht mit dem Maßstab einer Radikaltherapie gemessen werden. Eine FT sollte nur im Rahmen von Studien durchgeführt werden. Im Falle einer Progression sollte eine Sekundärbehandlung der Prostata effektiv durchführbar sein.
Abstract
Introduction
Patients with low-risk prostate cancer (PCa) face the difficult decision between a potential overtreatment by one of the standard therapies and active surveillance (AS) with the potential insecurity regarding cancer control. A focal therapy (FT) implies a treatment of the tumor within the prostate only.
Methods
This review evaluates the current literature and expert opinion of different therapies suited for FT as well as concepts for prostate imaging, biopsy and histopathological evaluation.
Results
Currently there is a lack of multicenter, randomized, prospective data on the effectiveness of FT. Nonetheless, the published data indicate a sufficient tumor control with a favorable side effect profile. There are still flaws in the diagnostics with regard to tumor detection and histological evaluation. Multicenter studies are currently recruiting worldwide which will provide new data with a higher level of evidence.
Conclusion
At present, the effectiveness of FT should not be compared directly to standard radical therapies and FT should only be performed within studies. In cases of cancer progression after FT a salvage treatment should still be possible.
Literatur
Cooperberg MR, Carroll PR, Klotz L (2011) Active surveillance for prostate cancer: progress and promise. J Clin Oncol 29(27):3669–3676. doi:JCO.2011.34.9738
Ruijter ET, Kaa CA van de, Schalken JA et al (1996) Histological grade heterogeneity in multifocal prostate cancer. Biological and clinical implications. J Pathol 180(3):295–299
Macintosh CA, Stower M, Reid N, Maitland NJ (1998) Precise microdissection of human prostate cancers reveals genotypic heterogeneity. Cancer Reals 58(1):23–28
Stamey TA, McNeal JE, Yemoto CM et al (1999) Biological determinants of cancer progression in men with prostate cancer. Jama 281(15):1395–1400
Noguchi M, Stamey TA, McNeal JE, Nolley R (2003) Prognostic factors for multifocal prostate cancer in radical prostatectomy specimens: lack of significance of secondary cancers. J Urol 170(2 Pt 1):459–463
Guo CC, Wang Y, Xiao L et al (2012) The relationship of TMPRSS2-ERG gene fusion between primary and metastatic prostate cancers. Hum Pathol 43(5):644–649
Liu W, Laitinen S, Khan S et al (2009) Copy number analysis indicates monoclonal origin of lethal metastatic prostate cancer. Nat Med 15(5):559–565
Eichler K, Hempel S, Wilby J et al (2006) Diagnostic value of systematic biopsy methods in the investigation of prostate cancer: a systematic review. J Urol 17(5):1605–1612
S3-Leitlinie_Version_2.0 Interdisziplinäre Leitlinie der Qualität S3 zur Früherkennung, Diagnose und Therapie der verschiedenen Stadien des Prostatakarzinoms Version 2.0 – 1. Aktualisierung 2011
Barzell WE, Melamed MR (2007) Appropriate patient selection in the focal treatment of prostate cancer: the role of transperineal 3-dimensional pathologic mapping of the prostate – a 4-year experience. Urology 70(6 Suppl):27–35
Hu JC, Yu HY, Kowalczyk KJ (2011) Challenges of interpreting and improving radical prostatectomy outcomes: technique, technology, training, and tactical reporting. Eur Urol 59(6):1073–1074
Ahmed HU, Kirkham A, Arya M et al (2009) Is it time to consider a role for MRI before prostate biopsy? Nat Rev Clin Oncol 6(4):197–206
Hadaschik BA, Kuru TH, Tulea C et al (2011) A novel stereotactic prostate biopsy system integrating pre-interventional magnetic resonance imaging and live ultrasound fusion. J Urol 186(6):2214–2220
Schouten MG, Bomers JG, Yakar D et al (2012) Evaluation of a robotic technique for transrectal MRI-guided prostate biopsies. Eur Radiol 22(2):476–483
Ahmed HU, Hindley RG, Dickinson L et al (2012) Focal therapy for localised unifocal and multifocal prostate cancer: a prospective development study. Lancet Oncol (Epub ahead of print)
Tatsutani K, Rubinsky B, Onik G, Dahiya R (1996) Effect of thermal variables on frozen human primary prostatic adenocarcinoma cells. Urology 48(3):441–447
Roberts CB, Jang TL, Shao YH et al (2011) Treatment profile and complications associated with cryotherapy for localized prostate cancer: a population-based study. Prostate Cancer Prostatic Dis 14(4):313–319
Onik G, Vaughan D, Lotenfoe R et al (2008) The „male lumpectomy“: focal therapy for prostate cancer using cryoablation results in 48 patients with at least 2-year follow-up. Urol Oncol 26(5):500-505. doi:S1078-1439(08)00052-5
Ellis DS, Manny TB, Jr, Rewcastle JC (2007) Focal cryosurgery followed by penile rehabilitation as primary treatment for localized prostate cancer: initial results. Urology 70(6 Suppl):9–15. doi:S0090-4295(07)01813-4
Lambert EH, Bolte K, Masson P, Katz AE (2007) Focal cryosurgery: encouraging health outcomes for unifocal prostate cancer. Urology 69(6):1117–1120. doi:S0090-4295(07)00289-0
Truesdale MD, Cheetham PJ, Hruby GW et al (2010) An evaluation of patient selection criteria on predicting progression-free survival after primary focal unilateral nerve-sparing cryoablation for prostate cancer: recommendations for follow up. Cancer J 16(5):544–549
Bahn D, de Castro Abreu AL, Gill IS et al (2012) Focal Cryotherapy for Clinically Unilateral, Low-Intermediate Risk Prostate Cancer in 73 Men with a Median Follow-Up of 3.7 Years. Eur Urol. doi:S0302-2838(12)00316-8
Lindner U, Weersink RA, Haider MA et al (2009) Image guided photothermal focal therapy for localized prostate cancer: phase I trial. J Urol 182(4):1371–1377
Moore CM, Pendse D, Emberton M (2009) Photodynamic therapy for prostate cancer--a review of current status and future promise. Nat Clin Pract Urol 6(1):18–30
Langley S, Ahmed HU, Al-Qaisieh B et al (2012) Report of a consensus meeting on focal low dose rate brachytherapy for prostate cancer. BJU Int 109(Suppl 1):7–16. doi:10.1111/j.1464-410X.2011.10825.x
Ahmed HU (2009) The index lesion and the origin of prostate cancer. N Engl J Med 361(17):1704–1706
Ahmed HU, Akin O, Coleman JA et al (2012) Transatlantic Consensus Group on active surveillance and focal therapy for prostate cancer. BJU Int 109(11):1636–1647
Epstein JI, Allsbrook WC, Jr, Amin MB, Egevad LL (2005) The 2005 International Society of Urological Pathology (ISUP) Consensus conference on gleason grading of prostatic carcinoma. Am J Surg Pathol 29(9):1228–1242
Xylinas E, Durand X, Campeggi A et al (2011) Pathological findings after radical prostatectomy in men eligible for active surveillance (French trial SURACAP): is the misclassification rate acceptable?. Prog Urol 21(4):264–269. doi:S1166-7087(10)00438-0
Helpap B, Köllermann J (2012) Combined histoarchitectural and cytological biopsy grading improves grading accuracy in low-grade prostate cancer. Int J Urol 19(2):126–133
Interessenskonflikt
Der korrespondierende Autor weist für sich und seine Koautoren auf folgende Beziehung/en hin: M. Schostak, U. Witzsch und A. Blana sind klinische Berater der Firma EDAP TMS. U. Witzsch ist klinischer Berater der Fa. Galil Medical. S. Machtens erhält Vortragshonorare durch die Firmen BARD, Bebig, Oncura sowie Drittmittel durch die Fa. BARD. Thomas Henkel erhält Vortragshonorare durch die Fa. Bebig. Die weiteren Autoren geben an, dass keine Interessenskonflikte bestehen.
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Baumunk, D., Blana, A., Ganzer, R. et al. Fokale Therapie des Prostatakarzinoms. Urologe 52, 549–556 (2013). https://doi.org/10.1007/s00120-012-3002-7
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DOI: https://doi.org/10.1007/s00120-012-3002-7