Skip to main content
SpringerLink
Log in

Selektionskriterien zum abwartenden Management des lokalisierten Prostatakarzinoms

Selection criteria for the expected management of localised prostate cancer

  • Leitthema
  • Published:
Der Urologe Aims and scope Submit manuscript

Zusammenfassung

Das Prostatakarzinom birgt wie kein anderer Tumor die Gefahr einer Übertherapie. Aufgrund des langsamen Wachstums von Prostatakarzinomen stellt deshalb ein so genanntes abwartendes Management ein mögliche therapeutische Option dar. Verbesserte diagnostische Methoden und die zunehmende Anwendung des PSA Tests erlauben eine frühere Karzinomdetektion mit der wachsenden Gefahr einer Therapie von Tumoren, welche die Lebenserwartung des betroffenen Mannes auch unbehandelt nicht beeinträchtigen würden. Es stehen verschiedenen statistische Modelle zur Verfügung, welche die histologische Relevanz eine Tumors einschätzen können; problematisch verbleibt jedoch die nur unzureichende Spezifität dieser Nomogramme. Zur Indikation eines abwartenden Managements muss auch die Komorbidität und das Lebensalter zusammengefasst in der zu erwartenden Lebenserwartung anhand bestehender Risiko-Scores und Statistiken berücksichtigt werden. Prinzipiell eignen sich am ehesten hoch differenzierte Karzinome bei älteren Patienten für ein abwartendes Management. Junge Patienten sowie mittelgradig und schlecht differenzierte Karzinome sollten am ehesten einer definitiven Therapie zugeführt werden.

Abstract

Prostate cancer harbours the possibility of overtreatment more than any other malignant disease. Due to its slow growth, expected management is an established therapeutic option in newly diagnosed carcinomas. Improved diagnostic methods and the widespread use of PSA lead to earlier diagnosis of cancers that would not adversely affect the life expectancy of the patient, even when they were left untreated. Several statistical models have been published to identify such insignificant cancers; however, all such nomograms suffer from limited sensitivity and specificity. For the indication of expected management, comorbidity and life expectancy must be considered using risk scores and life tables. In general, expected management is a suitable option for elderly patients with low grade cancers. Young patients and those with intermediate or high-grade cancers are most likely to benefit from active local treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb 1

Literatur

  1. Albertsen PC, Hanley JA, Fine J (2005) 20-year outcomes following conservative management of clinically localized prostate cancer. JAMA. 293(17): 2095–2101

    Google Scholar 

  2. Alibhai SMH, Krahn MD, Cohen MM (2000) Older patents receive less aggressive treatment for clinically localized prostate cancer. Clin Invest Med 23: 332

    Google Scholar 

  3. Anast JW, Andriole GL, Bismar TA, Yan Y, Humphrey PA (2004) Relating biopsy and clinical variables to radical prostatectomy findings: can insignificant and advanced prostate cancer be predicted in a screening population? Urology 64(3): 544–550

    Article  PubMed  Google Scholar 

  4. Augustin H, Hammerer PG, Graefen M et al. (2003) Insignificant prostate cancer in radical prostatectomy specimen: time trends and preoperative prediction. Eur Urol 43(5): 455–460

    Article  PubMed  Google Scholar 

  5. Barry MJ, Albertsen PC, Bagshaw MA et al. (2001) Outcomes for Men with clinically nonmetastatic prostate carcinoma managed with radical prostatectomy, external beam radiotherapy or expectant management. Cancer 91: 2302–2314

    Article  PubMed  Google Scholar 

  6. Carter HB, Sauvageot J, Walsh PC, Epstein JI (1997) Prospective evaluation of men with stage T1C adenocarcinoma of the prostate. J Urol 157(6): 2206–2209

    Article  PubMed  Google Scholar 

  7. Carter HB, Walsh PC, Landis P, Epstein JI (2002) Expectant management of nonpalpable prostate cancer with curative intent: preliminary results.J Urol 167(3): 1231–1234

    Article  PubMed  Google Scholar 

  8. Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis 40(5): 373–383

    Article  PubMed  Google Scholar 

  9. Cooperberg MR, Broering JM, Litwin MS, Lubeck DP, Mehta SS, Henning JM, Carroll PR; CaPSURE Investigators (2004) The contemporary management of prostate cancer in the United States: lessons from the cancer of the prostate strategic urologic research endeavor (CapSURE), a national disease registry. J Urol 171(4): 1393–1401

    Article  PubMed  Google Scholar 

  10. Cupp MR, Bostwick DG, Myers RP, Oesterling JE (1995) The volume of prostate cancer in the biopsy specimen cannot reliably predict the quantity of cancer in the radical prostatectomy specimen on an individual basis. J Urol 153(5): 1543–1548

    Article  PubMed  Google Scholar 

  11. Epstein JI, Chan DW, Sokoll LJ et al. (1998) Nonpalpable stage T1c prostate cancer: prediction of insignificant disease using free/total prostate specific antigen levels and needle biopsy findings. J Urol 160(6 Pt 2): 2407–2411

    Article  PubMed  Google Scholar 

  12. Epstein JI, Walsh PC, Carmichael M, Brendler CB (1994) Pathologic and clinical findings to predict tumor extent of nonpalpable (stage T1c) prostate cancer. JAMA 271(5): 368–374

    Article  PubMed  Google Scholar 

  13. Elgamal AA, Van Poppel HP, Van de Voorde WM, Van Dorpe JA, Oyen RH, Baert LV (1997) Impalpable invisible stage T1c prostate cancer: characteristics and clinical relevance in 100 radical prostatectomy specimens — a different view. J Urol 157(1): 244–250

    Article  PubMed  Google Scholar 

  14. Franks LM (1954) Latent carcinoma of the prostate. J Pathol Bacteriol 68(2): 603–616

    Article  PubMed  Google Scholar 

  15. Froehner M, Koch R, Litz R, Oehlschlaeger S, Wirth MP (2004) Which conditions contributing to the charlson score predict survival after radical prostatectomy J Urol 171: 697–699

    Google Scholar 

  16. Goto Y, Ohori M, Arakawa A, Kattan MW, Wheeler TM, Scardino PT (1996) Distinguishing clinically important from unimportant prostate cancers before treatment: value of systematic biopsies. J Urol 156(3): 1059–1063

    Article  PubMed  Google Scholar 

  17. Holmberg L, Bill-Axelson A, Helgesen F, Salo JO, Folmerz P, Haggman M, Andersson SO, Spangberg A, Busch C, Nordling S, Palmgren J, Adami HO, Johansson JE, Norlen BJ; Scandinavian Prostatic Cancer Group Study Number 4 (2002) A randomized trial comparing radical prostatectomy with watchful waiting in early prostate cancer. N Engl J Med 347(11): 781–789

    Article  PubMed  Google Scholar 

  18. Irwin MB, Trapasso JG (1994) Identification of insignificant prostate cancers: analysis of preoperative parameters Urology 44(6): 862–867

  19. Jemal A, Thomas A, Murray T, Thun M (2002) Cancer statistics, 2002. CA Cancer J Clin 52(1): 23–47

    PubMed  Google Scholar 

  20. Johansson JE, Andren O, Andersson SO, Dickman PW, Holmberg L, Magnuson A, Adami HO (2004) Natural history of early, localized prostate cancer. JAMA 291(22): 2713–2719

    Article  PubMed  Google Scholar 

  21. Kaplan MH, Feinstein AR (1974) The importance of classifying initial comorbidity in evaluating the outcome of diabetes mellitus. J Chron Dis 27: 387–404

    Article  PubMed  Google Scholar 

  22. Kattan MW, Eastham JA, Wheeler TM et al. (2003) Counseling men with prostate cancer: a nomogram for predicting the presence of small, moderately differentiated, confined tumors. J Urol 170(5): 1792–1797

    Article  PubMed  Google Scholar 

  23. Klein EA (2004) What is ‚insignificant‘ prostate carcinoma? Cancer 101(9): 1923–1925

    Article  PubMed  Google Scholar 

  24. Noguchi M, Stamey TA, McNeal JE, Yemoto CM (2001) Relationship between systematic biopsies and histological features of 222 radical prostatectomy specimens: lack of prediction of tumor significance for men with nonpalpable prostate cancer. J Urol 166(1): 104–109

    Article  PubMed  Google Scholar 

  25. Panagiotou I, Beer TM, Hsieh YC, Mori M, Peters L, Klein T, Garzotto M (2004) Predictors of delayed therapy after expectant management for localized prostate cancer in the era of prostate-specific antigen. Oncology 67(3–4): 194–202

    Google Scholar 

  26. Patel MI, DeConcini DT, Lopez-Corona E, Ohori M, Wheeler T, Scardino PT (2004) An analysis of men with clinically localized prostate cancer who deferred definitive therapy. J Urol 171(4): 1520–1524

    Article  PubMed  Google Scholar 

  27. Schlomm T, Luebke AM, Sultmann H et al. (2005) Extraction and processing of high quality RNA from impalpable and macroscopically invisible prostate cancer for microarray gene expression analysis. Int J Oncol 27(3): 713–720

    PubMed  Google Scholar 

  28. Shabbir Alibhai SM, Naglie G, Nam R, Trachtenberg J, Krahn MD (2003) Do older men benefit from curative therapy of localized prostate cancer? J Clin Oncol 21(17): 3318–3327

    Article  PubMed  Google Scholar 

  29. Schirrmacher F (2004) Das Methusalem-Komplott. Blessing, München

  30. Singh R, O’Brien TS (2004) Comorbidity assessment in localized prostate cancer: A review of currently available techniques. Eur Urol 46: 28–41

    Article  PubMed  Google Scholar 

  31. Stamey TA, Freiha FS, McNeal JE, Redwine EA, Whittemore AS, Schmid HP (1993) Localized prostate cancer. Relationship of tumor volume to clinical significance for treatment of prostate cancer. Cancer 71(3 Suppl): 933–938

    PubMed  Google Scholar 

  32. Steinberg GD, Bales GT, Brendler CB (1998) An analysis of watchful waiting for clinically localized prostate cancer. J Urol 159(5): 1431–1436

    Article  PubMed  Google Scholar 

  33. Sweat SD, Bergstralh EJ, Slezak J, Blute ML, Zincke H(2002) Competing risk analysis after radical prostatectomy for clincally nonmetastatic prostate adenocarcinoma according to clincal gleason score and patient age. J Urol 168: 525–529

    Article  PubMed  Google Scholar 

  34. StatistischesBundesamt 004:http://www.destatis.de/download/d/bevoe/sterbet03.xls

  35. Thompson KE, Hernandez J, Canby-Hagino ED, Troyer D, Thompson IM (2005) Prognostic features in men who died of prostate cancer. J Urol 174(2): 553–556

    Article  PubMed  Google Scholar 

  36. Wirth MP, Froehner M (2004) he significance of comorbidity and age in radical prostatectomy. Urologe A 43(10): 935–941

    Google Scholar 

  37. Wu H, Sun L, Moul JW et al. (2004) Watchful waiting and factors predictive of secondary treatment of localized prostate cancer. J Urol 171(3): 1111–1116

    Article  PubMed  Google Scholar 

  38. Yan Y, Carcalhal GF, Catalona WJ (2000) Primary treatment choices form men with clinically localized prostate carcinoma detected by screening. Cancer 88: 1112–1130

    Article  Google Scholar 

Download references

Interessenkonflikt:

Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen.

Author information

Authors and Affiliations

  1. Martini-Klinik, Prostatazentrum an der Universitätsklinik Hamburg-Eppendorf

    M. Graefen, C. Eichelberg, T. Schlomm & H. Huland

  2. Klinik und Poliklinik für Urologie, Universitätsklinik Hamburg-Eppendorf

    M. Graefen, G. Salomon, E. Currlin & H. Huland

  3. Martini-Klinik, Prostatazentrum an der Universitätsklinik Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg

    M. Graefen

Authors
  1. M. Graefen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. G. Salomon
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. E. Currlin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. C. Eichelberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. T. Schlomm
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. H. Huland
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Graefen.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Graefen, M., Salomon, G., Currlin, E. et al. Selektionskriterien zum abwartenden Management des lokalisierten Prostatakarzinoms. Urologe 44, 1277–1286 (2005). https://doi.org/10.1007/s00120-005-0924-3

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00120-005-0924-3

Schlüsselwörter

Keywords

Search

Navigation