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Positronenemissionstomographie bei urologischen Tumorerkrankungen

Positron-emission tomography in urooncology

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An Erratum to this article was published on 05 September 2015

Zusammenfassung

Die Positronenemissionstomograpie (PET) wird bei urologischen Tumorentitäten seit vielen Jahren verwendet. Hierbei kommen verschiedene Tracersubstanzen zum Einsatz, die metabolische Informationen anzeigen oder auf einem direkten Nachweis molekularer Zielstrukturen beruhen. Während sie im Staging des Seminoms in Form der 18F-Fluordeoxyglukose- (18F-FDG-)PET als Standardverfahren Einzug in die Leitlinien gefunden haben, ist die PET aufgrund Ermangelung spezifischer Tracer bei Nierentumoren in der Routine bisher nicht etabliert. Trotz anfänglicher Euphorie scheint die PET mit 18F-FDG oder cholinbasierten Tracern auch beim Urothelkarzinom der Blase meist keinen relevanten diagnostischen Mehrwert zu erbringen und sollte daher hier mit Zurückhaltung bzw. nur im Rahmen von Studien Anwendung finden. Beim Prostatakarzinom dagegen zeichnet sich mit Hilfe neuer Tracer, die beispielsweise das prostataspezifische Membranantigen (PSMA) als Zielstruktur haben, eine Trendwende in der bisherigen Diagnostik ab. Hier scheint sich die „68Ga-PSMA-PET“ als zukünftige Standarddiagnostik zu etablieren.

Abstract

The use of positron emission tomography (PET) is an established method for the diagnosis of urological malignancies. Several tracers are currently available to obtain metabolic information or directly detect molecular targets. While 18F-FDG-PET is recognized in current guidelines for the staging of seminoma, PET is not used in clinical routine in renal malignancies due to the lack of specific tracers. Despite initial promising results in bladder cancer, no relevant additional diagnostic value with PET using 18F-FDG or choline-based tracers could be obtained in most patients and therefore should be used with caution or only within clinical trials. In prostate cancer, however, after development of new tracers that, for example, target prostate-specific membrane antigen (PSMA), a paradigm shift in imaging can be recognized. Here, 68Ga-PSMA-PET might be included in the future as part of standard imaging work-up.

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Abbreviations

FDG:

Fluorodeoxyglukose

Ga:

Gallium

PSMA:

prostataspezifisches Antigen

PET:

Positronenemissionstomographie

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Einhaltung ethischer Richtlinien

Interessenkonflikt. T. Maurer, H. Kübler, J.E. Gschwend und M. Eiber geben an, dass kein Interessenkonflikt besteht. Alle im vorliegenden Manuskript beschriebenen Untersuchungen am Menschen wurden mit Zustimmung der zuständigen Ethik-Kommission, im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung) durchgeführt. Von allen beteiligten Patienten liegt eine Einverständniserklärung vor.

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  1. Urologische Klinik und Poliklinik, Technische Universität München, Klinikum rechts der Isar, Ismaninger Straße 22, 81671, München, Deutschland

    T. Maurer, H. Kübler & J.E. Gschwend

  2. Nuklearmedizinische Klinik und Poliklinik, Technische Universität München, Klinikum rechts der Isar, München, Deutschland

    M. Eiber

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Maurer, T., Kübler, H., Gschwend, J. et al. Positronenemissionstomographie bei urologischen Tumorerkrankungen. Urologe 54, 983–991 (2015). https://doi.org/10.1007/s00120-015-3868-2

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