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Risikoadaptiertes PSA-Screening und die PROBASE-Studie

Risk-adapted PSA screening and the PROBASE trial

  • Leitthema
  • Published:
Der Onkologe Aims and scope

Zusammenfassung

Hintergrund

Das Prostatakarzinom ist der häufigste maligne Tumor des Mannes. In den letzten Jahrzehnten ist es zu einer deutlichen Inzidenzzunahme gekommen, die auf den vermehrten Einsatz des prostataspezifischen Antigens (PSA) als Früherkennungsmethode zurückzuführen ist. Der im gleichen Zeitraum beobachtete Rückgang der Mortalität ist jedoch nur verhältnismäßig gering.

Ziel der Arbeit

Ziel der Arbeit ist eine Darstellung der Imbalance zwischen Nutzen und Nachteilen eines generellen PSA-Screenings und das Aufzeigen von neuen Lösungsansätzen durch ein risikoadaptiertes PSA-Screening auf Grundlage eines Baseline-PSA-Werts in der 5. Lebensdekade.

Methoden

Diese Arbeit basiert auf einer selektiven Literaturrecherche in der Datenbank PubMed zum Thema generelles PSA-Screening, risikoadaptiertes PSA-Screening und Baseline-PSA.

Ergebnisse

Ein generelles PSA-Screening reduziert die Mortalität des Prostatakarzinoms zwar um bis zu 30  %, geht jedoch gleichzeitig mit einer >  50  %igen Rate an Überdiagnose und Übertherapie einher. Die Bestimmung eines Baseline-PSA-Werts in der 5. Lebensdekade ermöglicht die Definition von Risikogruppen mit risikoadaptierten Screeningintervallen in Abhängigkeit von der individuellen Höhe des Baseline-PSA-Werts. Dieses Konzept wird derzeit im Rahmen der multizentrischen PROBASE-Studie an 50.000 45-jährigen Männern prospektiv evaluiert.

Diskussion

Risikoadaptierte Screeningintervalle in Abhängigkeit vom Baseline-PSA-Wert können das ungünstige Verhältnis zwischen Nutzen und Nachteil eines generellen PSA-Screenings deutlich verbessern, indem sie die Anzahl unnötiger diagnostischer und therapeutischer Maßnahmen – bei gleichzeitig erhaltener hoher Sensitivität des PSA-Tests – signifikant reduzieren.

Abstract

Background

Prostate cancer is the most common type of cancer in men. Within the last decades a significant increase in incidence has been observed which is attributed to the widespread use of prostate-specific antigen (PSA) for early detection; however, during the same period the decrease in mortality was only modest.

Objective

To determine the imbalance of benefits and disadvantages of a general PSA screening and to illustrate how risk-adapted screening intervals based on a baseline PSA value in the fifth decade of life can improve the benefits-disadvantages ratio of a general PSA screening program.

Methods

A selective literature search in PubMed on general PSA screening, risk-adapted PSA screening and baseline PSA was performed.

Results

General PSA screening reduces prostate cancer mortality by 30   %; however, this reduction of mortality is accompanied by a > 50   % rate of overdiagnosis and overtreatment. The assessment of a baseline PSA value in the fifth decade of life allows a definition of risk groups and subsequent risk-adapted PSA screening intervals. Currently, this concept is prospectively being validated in 50,000 45-year-old men within the multicenter PROBASE trial.

Discussion

A risk-adapted PSA screening strategy with screening intervals based on a baseline PSA value can improve the unfavorable benefits-disadvantages ratio observed in general PSA screening programs. Thus, the number of unnecessary diagnostic and treatment procedures is significantly reduced with a concurrent high sensitivity.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. C. Arsov, N. Becker und P. Albers geben an, dass kein Interessenkonflikt besteht.

Der Beitrag enthält keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klinik für Urologie, Universitätsklinikum Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland

    C. Arsov & P. Albers

  2. DKFZ Heidelberg, Heidelberg, Deutschland

    N. Becker

Authors
  1. C. Arsov
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  2. N. Becker
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  3. P. Albers
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Correspondence to C. Arsov.

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Arsov, C., Becker, N. & Albers, P. Risikoadaptiertes PSA-Screening und die PROBASE-Studie. Onkologe 21, 778–786 (2015). https://doi.org/10.1007/s00761-014-2897-6

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  • DOI: https://doi.org/10.1007/s00761-014-2897-6

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