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Metachron oligometastasiertes Prostatakarzinom – viel hilft viel oder alleinige lokale Therapie?

Metachronous oligometastatic prostate cancer—the more the better or only local treatment?

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Zusammenfassung

Hintergrund

Prostatakarzinommetastasen können zum Zeitpunkt der Diagnose (de novo) oder metachron nach zunächst lokalisierter Erkrankung entstehen.

Fragestellung

Lokalisation, Prognose und individuelle Therapie der metachronen Oligometastasierung sollen dargestellt werden.

Material und Methode

Aktuelle Therapierrichtlinien und Literatur zur Therapie des hormonsensitiven, metachron oligometastasierten Prostatakarzinoms werden analysiert.

Ergebnisse

Moderne bildgebende Verfahren führen zur frühzeitigen Diagnose der metachronen Metastasierung im oligometastatischen Stadium und eröffnen die Möglichkeit der metastasengerichteten Therapie. Das metachron metastasierte Prostatakarzinom kann als lokoregionäre Lymphknotenmetastasierung (N1) oder Fernmetastasierung auftreten. Im Vordergrund bei der N1-Situation steht die Metastasenbehandlung durch chirurgische Exstirpation oder Bestrahlung. Fernmetastasen können im Rahmen eines individuellen Konzepts bestrahlt werden, um den Beginn einer medikamentösen Therapie herauszuzögern. Die Kombination aus Androgenentzug und Apalutamid oder Enzalutamid gelten als medikamentöse Standardtherapie der M1-Situation mit deutlichem Überlebensvorteil gegenüber der alleinigen Kastration.

Schlussfolgerung

Das metachron oligometastasierte Prostatakarzinom ist ein heterogenes Krankheitsbild mit langsamerer Progression im Vergleich zur primären High-volume-Metastasierung. Individuelle Therapiekonzepte verlangsamen signifikant die Progression bei guter Verträglichkeit. Multimodale Behandlungen werden derzeit in prospektiven Studien evaluiert.

Abstract

Background

Prostate cancer metastases may occur at diagnosis (de novo) or metachronous after treatment for localized disease.

Objective

To describe location, prognosis, and individual treatment concepts for metachronous oligometastatic prostate cancer.

Materials and methods

Analysis of current treatment guidelines and literature for hormone sensitive, metachronous metastatic prostate cancer.

Results

Modern imaging modalities lead to earlier diagnosis of metachronous oligometastatic prostate cancer, which offers the opportunity to develop metastasis-directed treatment concepts. Oligometastatic recurrence may occur in locoregional lymph nodes (N1) or as distant disease (M1). N1 disease is predominantly treated by salvage lymph node dissection or radiation. Distant metastasis may be radiated in order to delay systemic treatment. The combination of androgen deprivation and novel androgen receptor-targeted drugs such as apalutamide or enzalutamide are associated with a significant survival benefit compared to castration alone in bone or visceral oligometastatic metachronous disease.

Conclusion

Metachronous oligometastatic prostate cancer is heterogeneous with slow progression compared to men with high volume metastasis. Individual treatment concepts may decrease risk of progression and, thus, delay time to medical treatment. Multimodal approaches are currently being evaluated in clinical trials.

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Abbreviations

ADT:

Androgendeprivationstherapie

BCR:

Biochemisches Rezidiv

CT:

Computertomographie

DNRT:

„Elective nodal radiotherapy“

EBRT:

Externe Strahlentherapie

MDT:

Metastasengerichtete/metastasendirektive Therapie

MHSPC:

Metastasiertes hormonsensitives Prostatakarzinom

MRT:

Magnetresonanztomographie

OS:

„Overall survival“, Gesamtüberleben

PC:

Prostatakarzinom

PET:

Positronenemissionstomographie

PFS:

Progessionsfreies Überleben

PSA:

Prostataspezifisches Antigen

PSAdt:

PSA-Verdopplungszeit

PSMA:

Prostataspezifisches Membranantigen

SBRT:

„Stereotactic body radiotherapy“

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Authors and Affiliations

  1. Martini-Klinik, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, Gebäude Ost 46, 20246, Hamburg, Deutschland

    T. Steuber & T. Maurer

  2. Klinik für Urologie, Universitätsklinikum Charite Berlin, Berlin, Deutschland

    K. Miller

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  1. T. Steuber
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  2. T. Maurer
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Correspondence to T. Steuber.

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T. Steuber, T. Maurer und K. Miller geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Steuber, T., Maurer, T. & Miller, K. Metachron oligometastasiertes Prostatakarzinom – viel hilft viel oder alleinige lokale Therapie?. Urologe 60, 1534–1545 (2021). https://doi.org/10.1007/s00120-021-01701-7

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