Zusammenfassung
Die Beziehung zwischen Prostatakrebs und dem metabolischen Syndrom (MS) ist komplex und facettenreich. Dies nicht zuletzt deswegen, weil das MS eine Mischung aus unterschiedlichen Konditionen und Erkrankungen darstellt, die ihrerseits in unterschiedlichen Kombinationen auftreten. Aus der Literatur ergeben sich zahlreiche Hinweise auf einen Zusammenhang zwischen dem MS oder einzelnen Komponenten und dem Auftreten eines Prostatakarzinoms (PCA), ohne dass die Datenlage eindeutig ist. Während das Vorliegen eines Diabetes das Auftreten eines PCA eher reduziert, korrelieren erhöhte Serumwerte für Triglyceride, Cholesterin und IGF-1 v. a. mit dem Auftreten gering differenzierter Tumoren. Weitere Untersuchungen sprechen dafür, dass ein MS oder hohe Insulinspiegel bei Patienten mit metastasiertem PCA prognostisch ungünstig sind. Nachdem sich der Krankheitsverlauf eines fortgeschrittenen PCA durch Früherkennung und verbesserte Therapieoptionen in den letzten Jahrzehnten erheblich verlängert hat, gewinnt die Entstehung eines MS unter Hormontherapie, mit den daraus resultierenden kardiovaskulären Risiken, zunehmend an Bedeutung. Prävention, Früherkennung und konsequente Behandlung eines MS unter Hormontherapie stellen daher heute eine wichtige klinische Herausforderung für den uroonkologisch tätigen Urologen dar.
Abstract
The relationship between metabolic syndrome (MS) and prostate cancer (PCA) is highly complex and harbors multiple facets not least because MS is not a single entity but represents a poorly defined inhomogeneous mixture of different diseases and conditions. Although numerous studies suggest a correlation between MS or components of MS and the development of prostate cancer, current evidence cannot be considered convincing. While diabetes appears to be inversely related to PCA, increased serum levels of triglycerides, cholesterol and insulin-like growth factor 1 (IGF-1) may be predictive for high grade disease. Further studies suggested that MS and high serum insulin levels are independent predictors of an unfavorable prognosis in patients with metastatic PCA. Early detection and improved therapeutic options have dramatically prolonged the course of the disease in advanced PCA through the last decades. As a consequence, development of MS in patients undergoing hormone therapy along with the cardiovascular risks has gained increasing relevance. Based on this evolution prevention, early detection and sustainable therapy represent an important clinical challenge to modern urologists active in urooncology.
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In Teilen gehalten auf dem 64. Kongress der Deutschen Gesellschaft für Urologie e. V. (DGU), Leipzig, 26. bis 29. September 2012.
Mitglieder des AK PUK sind: J. Altwein, München; C. Fischer, Bayreuth; T. Klotz, Amberg; G. Lümmen, Troisdorf; M.J. Mathers, Remscheid; V. Rohde, Bad Schwartau; R. Schaefer, Bonn; B.J. Schmitz-Dräger, Fürth; F. Sommer, Hamburg; A. Schroeder, Neumünster; P. Thelen, Göttingen.
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Schmitz-Dräger, B., Lümmen, G., Bismarck, E. et al. Metabolisches Syndrom und Prostatakarzinom. Urologe 52, 842–846 (2013). https://doi.org/10.1007/s00120-013-3135-3
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DOI: https://doi.org/10.1007/s00120-013-3135-3