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Therapie des lokal fortgeschrittenen Prostatakarzinoms

Treatment of locally advanced prostate cancer

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Zusammenfassung

Die Therapie des klinisch lokal fortgeschrittenen Prostatakarzinoms (cT3) wird kontrovers beurteilt. Es handelt sich um ein Mischstadium mit einem erheblichen Anteil an falsch eingeschätzten T2-Tumoren sowie auch lymphknotenpositiven Patienten. Therapieoptionen sind die radikale Prostatektomie, die externe Strahlentherapie, die Hormontherapie (sofort oder verzögert) sowie das sog. „watchful waiting“. In vielen Fällen kommt eine multimodale Therapie zum Einsatz.

Für die radikale Prostatektomie können auch im klinischen Stadium T3 akzeptable tumorspezifische Überlebensraten erreicht werden. Vorraussetzung hierfür ist eine gute Selektion. Dadurch können tumorspezifische Überlebensraten für pT3-Tumoren erreicht werden, die denen von pT2-Tumoren nahe kommen. Liegen nach radikaler Prostatektomie Lymphknotenmetastasen vor, so scheint eine adjuvante Hormontherapie das Überleben zu verlängern, im Stadium pT3 ohne Lymphknotenbefall dagegen nicht.

Der Nutzen einer adjuvanten Strahlentherapie nach radikaler Prostatektomie im Stadium pT3 ist nicht nachgewiesen; obwohl sie ein biochemisches Rezidiv verhindern oder verzögern kann, ist eine Verlängerung des Gesamtüberlebens nicht nachweisbar. Die alleinige lokale Strahlentherapie des cT3-Prostatakarzinoms ergibt ungünstige tumorspezifische Überlebensraten. Hier ist jedoch eine deutliche Verbesserung durch eine adjuvante Hormontherapie mittels LHRH-Analoga nachgewiesen. Wird aufgrund signifikanter Begleiterkrankungen oder fortgeschrittenen Alters ein lokal fortgeschrittenes Prostatakarzinom primär hormonell behandelt, so scheint der frühzeitige Beginn einer hormonellen Therapie das Überleben geringfügig zu verlängern.

Abstract

The management of clinically locally advanced prostate carcinoma (cT3) remains a controversial issue. The clinical stage cT3 consists of a mixture of overstaged T2 carcinomas but also contains lymph node-positive cases. Treatment options consist of radical prostatectomy, external beam radiotherapy, hormonal deprivation (early or delayed) and the so-called watchful waiting. In many cases multimodal therapy is used.

Radical prostatectomy in the clinical stage T3 can achieve acceptable tumour-specific survival rates if patients are well selected. In this way, tumour-specific survival rates can be reached for pT3 patients which closely approach those of pT2 cases. In lymph node-positive cases after radical prostatectomy adjuvant hormonal treatment can prolong survival, but not in lymph node-negative cases.

A benefit of adjuvant radiotherapy after radical prostatectomy has not been proven. Although it can postpone or prevent biochemical recurrence, it does not prolong overall survival. Treatment of stage cT3 by external beam radiotherapy alone results in unfavourable tumour-specific survival rates. In these cases definite improvement can be achieved by adjuvant androgen deprivation with LHRH analogues. If in case of severe comorbidity or advanced age primary hormonal treatment is chosen, early vs deferred treatment seems to prolong survival marginally.

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  1. Klinik und Poliklinik für Urologie, Universitätsklinikum Carl Gustav Carus, Technische Universität, Dresden

    M. P. Wirth, O. W. Hakenberg & M. Fröhner

  2. Klinik und Poliklinik für Urologie, Universitätsklinikum Carl Gustav Carus, Technische Universität, Fetscherstraße 74, 01307, Dresden

    M. P. Wirth

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Wirth, M.P., Hakenberg, O.W. & Fröhner, M. Therapie des lokal fortgeschrittenen Prostatakarzinoms. Urologe 44, 1295–1302 (2005). https://doi.org/10.1007/s00120-005-0927-0

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