Skip to main content
Log in

Fokale Therapie des Prostatakarzinoms

Möglichkeiten, Limitierungen und Ausblick

Focal prostate cancer therapy

Capabilities, limitations and prospects

Der Urologe Aims and scope Submit manuscript

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.

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

Access this article

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

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5

Literatur

  1. 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

    Article  PubMed  Google Scholar 

  2. 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

    Article  PubMed  CAS  Google Scholar 

  3. Macintosh CA, Stower M, Reid N, Maitland NJ (1998) Precise microdissection of human prostate cancers reveals genotypic heterogeneity. Cancer Reals 58(1):23–28

    CAS  Google Scholar 

  4. Stamey TA, McNeal JE, Yemoto CM et al (1999) Biological determinants of cancer progression in men with prostate cancer. Jama 281(15):1395–1400

    Article  PubMed  CAS  Google Scholar 

  5. 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

    Article  PubMed  Google Scholar 

  6. 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

    Article  PubMed  CAS  Google Scholar 

  7. 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

    Article  PubMed  CAS  Google Scholar 

  8. 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

    Article  Google Scholar 

  9. 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

  10. 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

    Article  PubMed  Google Scholar 

  11. 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

    Article  PubMed  Google Scholar 

  12. 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

    Article  PubMed  Google Scholar 

  13. 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

    Article  PubMed  Google Scholar 

  14. 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

    Article  PubMed  Google Scholar 

  15. 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)

  16. 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

    Article  PubMed  CAS  Google Scholar 

  17. 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

    Article  PubMed  CAS  Google Scholar 

  18. 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

    Article  PubMed  Google Scholar 

  19. 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

    Article  PubMed  Google Scholar 

  20. 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

    Article  PubMed  Google Scholar 

  21. 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

    Article  PubMed  Google Scholar 

  22. 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

  23. 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

    Article  PubMed  CAS  Google Scholar 

  24. 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

    Article  PubMed  CAS  Google Scholar 

  25. 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

    Article  PubMed  Google Scholar 

  26. Ahmed HU (2009) The index lesion and the origin of prostate cancer. N Engl J Med 361(17):1704–1706

    Article  PubMed  CAS  Google Scholar 

  27. 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

    Article  PubMed  Google Scholar 

  28. 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

    Article  PubMed  Google Scholar 

  29. 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

    Article  PubMed  CAS  Google Scholar 

  30. 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

    Article  PubMed  Google Scholar 

Download references

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.

Author information

Authors and Affiliations

Authors

Consortia

Corresponding author

Correspondence to D. Baumunk F.E.B.U.

Rights and permissions

Reprints and permissions

About this article

Cite this article

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

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00120-012-3002-7

Schlüsselwörter

Keywords

Navigation