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Diagnostik und Therapie des PSA-Progresses nach lokaler Primärtherapie des Prostatakarzinoms

Diagnostics and treatment of PSA progression after local primary therapy of prostate cancer

  • Leitthema
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Zusammenfassung

Der Anstieg des prostataspezifischen Antigens nach radikaler Prostatektomie (RP) oder nach kurativer Strahlentherapie (RT) ist das frühe Zeichen einer Tumorprogression. Die aktuelle Definition nach RP ist 0,4 ng/ml und weiter steigend, die nach RT Nadir + 2 ng/ml. Die Prognose dieser Patienten ist heterogen. Die wesentlichen Prognoseparameter sind Gleason-Score, Zeit bis zum Auftreten der PSA-Progression und PSA-Verdopplungszeit (PSA-DT). Bildgebende Verfahren spielen in der frühen Phase (PSA<0,5 ng/ml) nach radikaler Prostatektomie, in der die Entscheidung für eine Salvage-RT getroffen werden muss, keine wesentliche Rolle. Nach kurativer Strahlentherapie ist für die Entscheidung zur lokalen Salvagetherapie (Prostatektomie, Kryotherapie, HIFU) eine Biopsie indiziert. Nach radikaler Prostatektomie erreichen im Langzeitverlauf ohne Therapie nur ca. 30% der Patienten das Stadium der klinischen Metastasierung, nach kurativer Strahlentherapie häufiger (bis 75%). Dies ist bei der Indikationsstellung zur Hormontherapie zu bedenken. Bei fehlenden aussagekräftigen prospektiven Studien sind der optimale Zeitpunkt und die Art der Hormontherapie derzeit nicht definiert.

Abstract

A rise of the prostate-specific antigen following radical prostatectomy (RP) or radiotherapy (RT) with curative intent is the earliest sign of tumor progression. The current definition after RP is 0.4 ng /ml and further rising, after RT nadir + 2 ng/ml. The prognosis of these patients is very heterogeneous, the relevant prognostic parameters being the Gleason Score, time to PSA progression, and PSA doubling time (PSA DT). Imaging studies are of limited value for the decision on salvage radiotherapy (following RP) as the decision must be taken very early in the course (PSA >0.5 ng/ml) to obtain acceptable results. Before local salvage therapy (salvage RP, cryosurgery, HIFU) is pursued after RT, a biopsy is necessary to confirm local tumor progression.

About 30% of patients with rising PSA following RP and no further therapy reach the stage of clinical metastases. This seems to be more common after RT (up to 75%). These figures must be taken into account when hormone therapy is decided upon. As no data from prospective studies are available, timing and modalities of hormone therapy are not defined.

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  1. Urologische Klinik, Charité – Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Deutschland

    K. Miller & A. Lingnau

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  1. K. Miller
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Correspondence to K. Miller.

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Miller, K., Lingnau, A. Diagnostik und Therapie des PSA-Progresses nach lokaler Primärtherapie des Prostatakarzinoms. Onkologe 13, 718–725 (2007). https://doi.org/10.1007/s00761-007-1228-6

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