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Fokale Therapie des Prostatakarzinoms in Deutschland

Focal therapy of prostate cancer in Germany

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Zusammenfassung

Hintergrund

Das Prostatakarzinom (PCa) ist der häufigste bösartige Tumor des Mannes. Durch das weit verbreitete PSA (prostataspezifisches Antigen)-Screening wird das PCa zunehmend in einem organbegrenzten Stadium diagnostiziert.

Methode

Traditionell beinhalten definitive Therapieoptionen für das organbegrenzte PCa die radikale Prostatektomie, die perkutane Strahlentherapie sowie die Brachytherapie. Hierbei sind jedoch therapiebedingte Nebenwirkungen wie Inkontinenz oder erektile Dysfunktion nicht selten. Nationale und internationale Leitlinien empfehlen als alternative Therapieoption die aktive Überwachung (Active Surveillance, AS) beim Niedrig-Risiko-PCa. Teilresektionen unter Erhalt des Organs werden bereits standardmäßig in anderen Organsystemen durchgeführt, wie z. B. im Bereich der Brustchirurgie beim Mammakarzinom. Die fokale Therapie (FT) beim PCa soll die Lücke zwischen den radikalen Therapieoptionen und der AS schließen und gleichzeitig die Nebenwirkungen reduzieren.

Ziel

In diesem Artikel werden die aktuell zur FT angebotenen Therapieoptionen beleuchtet, insbesondere bezüglich ihrer Einschränkungen und Zukunftsperspektiven. Aktuell sind verschiedene Therapieoptionen zur FT beim PCa verfügbar. Diese finden jedoch noch im Rahmen klinischer Studien Anwendung und sind für eine routinemäßige Therapie noch nicht zugelassen. Erste Ergebnisse scheinen einen klinischen Benefit der FT zu belegen, die Ergebnisse der laufenden Studien stehen jedoch weitestgehend aus.

Abstract

Background

Prostate cancer (PCa) is the most common cancer in men, which is increasingly diagnosed at a localized stage due to the widespread use of PSA (prostate-specific antigen)-screening.

Method

Traditionally, definite treatment options for PCa include radical prostatectomy, external beam radiotherapy, or brachytherapy. However, treatment-related side effects such as urinary incontinence and erectile dysfunction are common. Alternatively, national and international guidelines recommend active surveillance (AS) as a treatment option for low-risk PCa. Organ-preserving surgery is commonly used in other organs, such as organ-conserving surgery for breast cancer. Focal therapy (FT) for PCa may close the gap between radical treatment options and active surveillance while reducing side effects.

Aim

This article highlights the current therapy options for FT in Germany including their limitations and perspectives. Currently, different therapy options are available for FT in PCa. However, the use of FT is still embedded in clinical trials and has not been approved for routine use yet. Initial results seem to be promising, but most studies are currently enrolling or have not been published yet.

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Authors and Affiliations

  1. Urologische Klinik und Poliklinik, Ludwig-Maximilians-Universität München, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland

    M. Apfelbeck, A. Herlemann, C. G. Stief & C. Gratzke

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  1. M. Apfelbeck
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  2. A. Herlemann
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  3. C. G. Stief
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  4. C. Gratzke
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Correspondence to M. Apfelbeck.

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Interessenkonflikt

M. Apfelbeck, A. Herlemann, C. G. Stief und C. Gratzke geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Apfelbeck, M., Herlemann, A., Stief, C.G. et al. Fokale Therapie des Prostatakarzinoms in Deutschland. Urologe 55, 584–592 (2016). https://doi.org/10.1007/s00120-016-0104-7

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