Zusammenfassung
In den letzten Jahren wurden neue Verfahren für die Bildgebung der Prostata entwickelt, um die Diagnostik des Prostatakarzinoms zu verbessern. Hierbei wurde v. a. der transrektale Ultraschall (TRUS) zum sog. „enhanced ultrasound“ weiterentwickelt. Die Elastographie zeigt in mehreren Studien gute Fähigkeiten, sowohl Karzinomherde in der Prostata zu identifizieren, als auch die Detektionsrate einer randomisierten Biopsie um bis zu 10 % absolut zu verbessern. Der Kontrastmittelultraschall zeigt unterschiedliche Ergebnisse in den publizierten Studien, mit z. T. verbesserten Detektionsraten und z. T. unveränderten Detektionsraten im Vergleich zur randomisierten Biopsie. Das „online“ verfügbare ANNA/C-TRUS-System weist mit 6 gezielten Biopsien Detektionsraten auf, welche mit den publizierten Daten der randomisierten Sättigungsbiopsie vergleichbar sind. Direkte systematische Vergleiche zur randomisierten Biopsie stehen jedoch noch aus. Zum Histoscanningsystem ist aktuell die unzureichendste Datenlage verfügbar, denn es liegen noch keine Biopsiestudien vor. Multizentrische Studien sind für sämtliche Bildgebungsverfahren notwendig, um diese Verfahren in der klinischen Praxis als Standard zu etablieren.
Abstract
Recently several new technologies for prostate imaging have been developed. The aim of these technologies was to improve the diagnosis of prostate cancer. Especially the transrectal ultrasound (TRUS) has been refined to the so-called enhanced ultrasound, as regular grey scale TRUS has limited ability to identify cancer lesions in the prostate. In several studies elastography has shown good capability to identify cancer lesions in the prostate as well as to absolutely increase the detection rate of randomized biopsies by up to 10 %.. Contrast-enhanced ultrasound shows varying results in the published literature with increased detection rates on the one hand and unchanged detection rates relative to randomized biopsy on the other hand. The online available ANNA/C-TRUS system shows detection rates with six targeted biopsies that are comparable to the published detection rates of randomized saturation biopsies. Direct systematic comparison to randomized biopsies is missing. The Histoscanning system currently provides the poorest data as no biopsy studies are available. Multicenter trials are mandatory for all new imaging technologies in order to implement them as standard into clinical practice.
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Der korrespondierende Autor weist für sich und seine Koautoren auf folgende Beziehungen hin: JW: Reiskostenübernahmen Fresenius-Kabi, Hitachi Medical System; TL: Beratungstätigkeit Fresenius-Kabi.
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Walz, J., Loch, T., Salomon, G. et al. Lokale Bildgebung der Prostata. Urologe 52, 490–496 (2013). https://doi.org/10.1007/s00120-012-3103-3
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DOI: https://doi.org/10.1007/s00120-012-3103-3