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Multiparametrische MRT der Prostata zum Therapiemonitoring nach Strahlentherapie

Multiparametric prostate MRI for follow-up monitoring after radiation therapy

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Zusammenfassung

Klinisches/methodisches Problem

Für Patienten mit Prostatakarzinom stellt die Radiatio eine potenziell kurative lokale Therapieoption dar. Im Rahmen der Nachsorge nach lokal kurativ intendierter Therapie wird aktuell der Verlauf des PSA-Werts (PSA prostataspezifisches Antigen) kontrolliert, der Einsatz bildgebender Verfahren wird lediglich bei symptomatischen Patienten und/oder zur Planung einer Salvagetherapie empfohlen.

Radiologische Standardverfahren

Die MRT der Prostata stellt derzeit die Methode der Wahl zur lokalen Rezidivdiagnostik dar.

Leistungsfähigkeit

Insbesondere in Verbindung mit funktionellen Untersuchungstechniken zeigen Studien gute Ergebnisse in der Primärdiagnostik. Zum Einsatz der MRT der Prostata in der Rezidivsituation wurden bisher nur wenige Studien mit heterogenem Studiendesign publiziert. Auch die in der MRT nach Bestrahlung sichtbaren Veränderungen in den unterschiedlichen Modalitäten sind noch wenig evaluiert.

Empfehlung für die Praxis

Da die ersten Studienergebnisse auch bei Patienten nach Radiatio viel versprechend sind, sollte bei unklarem PSA-Anstieg und vorhandener Therapieoption eine MRT der Prostata zur Klärung der lokalen Situation in Betracht gezogen werden.

Abstract

Clinical/methodical issue

Radiation therapy is a therapeutic option with curative intent for patients with prostate cancer. Monitoring of prostate-specific antigen (PSA) values is the current standard of care in the follow-up. Imaging is recommended only for symptomatic patients and/or for further therapeutic options.

Standard radiological methods

For detection of local recurrence magnetic resonance imaging (MRI) of the prostate is acknowledged as the method of choice.

Performance

Good results for primary diagnosis were found especially in combination with functional techniques, whereas in recurrent prostate cancer only few studies with heterogeneous study design are available for prostate MRI. Furthermore, changes in different MRI modalities due to radiation therapy have been insufficiently investigated to date.

Practical recommendations

As the initial results were promising prostate MRI and available therapeutic options for detection of local recurrence should be considered in patients with increased PSA.

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Authors and Affiliations

  1. Institut für Klinische Radiologie und Nuklearmedizin, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim der Universität Heidelberg, Theodor-Kutzer-Ufer 1–3, 68167, Mannheim, Deutschland

    A.M. Weidner, D.J. Dinter, M. Bohrer, M. Sertdemir, D. Hausmann, F. Wenz & S.O. Schoenberg

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  1. A.M. Weidner
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  2. D.J. Dinter
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  3. M. Bohrer
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  4. M. Sertdemir
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  5. D. Hausmann
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  6. F. Wenz
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  7. S.O. Schoenberg
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Correspondence to A.M. Weidner.

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Weidner, A., Dinter, D., Bohrer, M. et al. Multiparametrische MRT der Prostata zum Therapiemonitoring nach Strahlentherapie. Radiologe 52, 235–242 (2012). https://doi.org/10.1007/s00117-011-2196-9

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  • DOI: https://doi.org/10.1007/s00117-011-2196-9

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