Rolle der zytoreduktiven radikalen Prostatektomie beim oligometastasierten Patienten

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Zusammenfassung

Hintergrund

Bis heute ist die Rolle der zytoreduktiven Chirurgie bei oligometastatischem Prostatakarzinom (PCa) unklar. Ziel der vorliegenden Arbeit ist es, einen Überblick über die aktuelle Literatur und Studien zu geben.

Ergebnisse

Die zytoreduktive radikale Prostatektomie (CRP) bei Patienten mit einem oligometastatischen Prostatakrebs ist durchführbar und sicher. Während die perioperativen Komplikationsraten vergleichbar zu Patienten mit einem Hochrisiko-PCa sind, stellen sich die postoperativen funktionellen Ergebnisse (Harninkontinenz und erektile Funktion) im Vergleich leicht schlechter dar – hauptsächlich aufgrund geringerer Raten an nervenerhaltenden Operationen und des vermehrten Einsatzes von Androgendeprivationstherapien (ADT). Bislang konnte ein onkologischer Nutzen der CRP nur in retrospektiven, multiinstitutionellen Datenbanken und Fall-Kontroll-Studien nachgewiesen werden, nicht jedoch in prospektiven Studien. Ein klares Argument zugunsten der CRP ist jedoch die Reduktion schwerer lokaler Komplikationen im Vergleich zu Patienten, die nur eine systemische Therapie erhalten (bis zu >50 % vs. <10 %).

Schlussfolgerung

Während der onkologische Einfluss einer CRP immer noch diskutiert wird, kann eine signifikante Reduktion lokaler Komplikationen als Argument für ihre Durchführung bei Patienten mit oligometastatischem PCa angesehen werden. Dennoch müssen Patienten hinsichtlich der relevanten Komplikationen und des schlechteren funktionellen Ergebnisses im Vergleich zum lokalisierten Hochrisiko-PCa aufgeklärt werden und sollten nur innerhalb klinischer Studien therapiert werden.

Schlüsselwörter

Zytoreduktive Prostatektomie Oligometastatisches Prostatakarzinom Funktionelle Ergebnisse Onkologische Ergebnisse Lokale Komplikationen 

Role of cytoreductive, radical prostatectomy in oligometastatic patients

Status quo

Abstract

Background

To date, the role of cytoreductive surgery in oligometastatic prostate cancer (PCa) remains unclear. The aim of the current review was to give an overview over the current literature und data.

Recent findings

Cytoreductive radical prostatectomy (CRP) in oligometastatic prostate cancer is safe and feasible. While perioperative complication rates are comparable to those of patients with high-risk PCa undergoing radical prostatectomy, postoperative functional outcomes (urinary continence and erectile function) are worse—mainly due to lower rates of nerve-sparing procedures and higher use of androgen deprivation therapy (ADT). So far, an oncological benefit of CRP could only be shown in retrospective, multi-institutional databases and case–control studies, but not in prospective trials. Nevertheless, a clear argument in favor of CRP is the reduction of severe local complications compared to patients receiving best systemic therapy (up to >50% vs. <10%).

Conclusions

While the oncologic impact of CRP is still a matter of debate, a significant reduction of local complications might be an argument favoring CRP in patients with oligometastatic PCa. Nevertheless, patients need to be counseled about the relevant complications and worse functional outcome compared to high-risk localized PCa and therefore should only undergo surgery within clinical trials.

Keywords

Cytoreductive radical prostatectomy Oligometastatic prostate cancer Functional outcome Oncological outcome Local complications 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

P. Mandel, M. Graefen und T. Steuber geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Copyright information

© Springer-Verlag GmbH Austria, ein Teil von Springer Nature 2018

Authors and Affiliations

  • Philipp Mandel
    • 1
    • 2
  • Markus Graefen
    • 2
  • Thomas Steuber
    • 2
  1. 1.Klinik für UrologieUniversitätsklinikum FrankfurtFrankfurt am MainDeutschland
  2. 2.Martini-Klinik ProstatakrebszentrumUniversitätsklinikum Hamburg-EppendorfHamburgDeutschland

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