Zusammenfassung
Prognostische Faktoren für das Prostatakarzinom müssen signifikant, unabhängig und wichtig sein. Signifikant bedeutet in diesem Zusammenhang, dass der Faktor nicht nur zufällig auftritt. Unabhängig bedeutet, dass er seinen Vorhersagewert behält, wenn neue Faktoren hinzukommen. Wichtig bedeutet, dass er direkt Therapieentscheidungen beeinflusst. Zu unterscheiden sind patienten-, tumor- und therapiebezogene prognostische Faktoren. Die Etablierung neuer Prognosefaktoren außerhalb dieser Systematik und ohne Berücksichtigung der methodischen Anforderungen an ihre Bewertung führt zu einer Inflation neuer Parameter ohne Bedeutung, da ein Patient immer nur einer prognostischen Gruppe zugeteilt werden kann. Gesicherte prognostische Faktoren des Prostatakarzinoms sind Metastasierung, Lymphknotenbefall, Grading, positive Schnittränder, extrakapsuläres Wachstum und Samenblasenbefall. Trotz der Flut neuer Biomarker hat bisher nur das PSA seinen prognostischen Wert zur Abschätzung des progressionsfreien Überlebens behalten.
Abstract
Prognostic factors in prostate cancer must be significant, independent and clinically important. “Significant” means the factor rarely occurs by chance, “independent” means the factor retains its value even when new factors are added and “clinically important” means the factor influences therapy. They should furthermore be classified into patient-related, tumor-related and treatment-related factors. If new prognostic factors are established without adherence to these guidelines, there results an exponential increase of meaningless parameters, as an individual patient can only belong to one prognostic group. Prognostic factors with established values are metastases, lymph node involvement, grade, positive margins, extracapsular extension and seminal vesical invasion. Among the classic and new biomarkers, only PSA has been of value for prediction of progression-free survival.
Key words:
Prostate cancer - Prognostic factors - Prostate-specific antigen
Literatur
-
1
Aaltomaa S, Eskelinen M, Lipponen P.
Expression of Cyclin A and D Proteins in Prostate Cancer and Their Relation to Clinopathological Variables and Patient Survival.
The Prostate.
1999;
38
175-182
-
2
Bauer J J, Connelly R R, Sesterhenn I A, Bettencourt M C, McLeod D G, Srivastava S, Moul J W.
Biostatistical modeling using traditional variables and genetic biomarkers for predicting the risk of prostate carcinoma recurrence after radical prostatectomy.
Cancer.
1997;
79
952-962
-
3
Bostwick D G.
Gleason Grading of Prostatic Needle Biopsies.
Am J Surg Pathol.
1994;
18
796-803
-
4 Boyle P. Epidemiologie des Prostatakarzinoms. In: Faul & Altwein (Hrsg.). Screening des Prostatakarzinoms Berlin: Springer 1995: 11-19
-
5
Bundrick W S, Culkin D J, Mata J A, Zitman R I, Venable D D.
Evaluation of the Current Indicence of Nodal Metastasis From Prostate Cancer.
J Surg Oncol.
1993;
52
269-271
-
6
Burke H B, Henson D E.
Criteria for prognostic factors and for an enhanced prognostic systern.
Cancer.
1993;
72
3131-3135
-
7 Byar D P, Corle D K. Analysis of prognostic factors for prostate cancer in the VACURG studies. In: Denis et al. (Hrsg.). Controlled Clinical Trials in Urologic Oncology New York: Raven 1984: 147-169
-
8
Cheng W S, Frydenberg M, Bergstralh E J, Larson-Keller J J, Zincke H.
Radical prostatectomy for pathologic stage c prostate cancer: Influence of pathologic variables and adjuvant treatment on disease outcome.
Urology.
1993;
42
283-291
-
9
Chodak G W, Thisted R A, Gerber G S, Johansson J E, Adolfsson J, Jones G W, Chisholm G D, Moskovitz B, Livne P M, Warner J.
Results of conservative management of clinically localized prostate cancer.
N Engl J Med.
1994;
330
242-248
-
10
Connolly J A, Shinohara K, Presti J C, Carroll P R.
Local recurrence after radical prostatectomy: Characteristics in size, location and relationship to PSA and surgical margins.
Urology.
1996;
47
225-231
-
11
D'Amico A V, Desjardin A, Chung A, Chen M H, Schultz D, Whittington R, Malkowicz S B, Wein A, Tomaszewski J E, Renshaw A A, Loughlin K, Richie J P.
Assessment of outcome prediction models for patients with localized prostate carcinoma managed with radical prostatectomy or external beam radiation therapy.
Cancer.
1998;
82
1887-1896
-
12
D'Amico A V, Whittington R, Malkowicz S B, Loughlin K, Schultz D, Schnall M, Tempany C M, Tomaszewski J E, Renshaw A, Wein A.
An analysis of the time course of postoperative prostate-specific antigen failure in patients with positive surgical margins: Implications on the use of adjuvant therapy.
Urology.
1996;
47
538-547
-
13
Dawson N A.
Apples and oranges: building a consensus for standardized eligibility criteria and end points in prostate cancer clinical trials.
J Clin Oncol.
1995;
16
3398-3405
-
14
De la Taille A, Buttyan R, Benson M C, Katz A E.
The role of tumor biomarkers as predictors of serum PSA recurrence after radical prostatectomy.
Semin Urol Oncol.
1998;
16
137-144
-
15
De Voogt H J, Suciu S, Sylvester R, Pavone-Macaluso M, Smith P H, de Pauw M.
Multivariate analysis of prognostic factors in patients with advanced prostatic cancer: results from 2 European Organization for Research on Treatment of Cancer trials.
J Urol.
1989;
141
883-888
-
16
Duncan W, Catton C N, Warde P, Gospodarowicz M K, Munro A J, Lakier R, Simm J, Panzarella T.
The influence of transurethral resection of prostate on prognosis of patients with adenocarcinoma of the prostate treated by radical radiotherapy.
Radiother Oncol.
1994;
31
41-50
-
17
Egawa S, Suyama K, Matsumoto K, Satoh T, Uchida T, Kuwao S, Koshiba K.
Improved predictability of extracapsular extension and seminal vesicle involvement based on clinical and biopsy findings in prostate cancer in Japanese men.
Urology.
1998;
52
433-440
-
18
Eisenberger M A, Crawford E D, Wolf M, Blumenstein B, McLeod D G, Benson R, Dorr F A, Benson M, Spaulding J T.
Prognostic Factors in Stage D2 Prostate Cancer; Important Implications for Future Trials: Results of a Cooperative Intergroup Study (INT.0036).
Semin Oncol.
1994;
21
613-619
-
19
Epstein J I.
Pathologic Evaluation of Prostatic Carcinoma: Critical Information for the Oncologist.
Oncology.
1996;
10
527-534
-
20
Fielding L P, Fenoglio-Preiser C M, Freedman L S.
The future of prognostic factors in outcome prediction for patients with cancer.
Cancer.
1992;
70
2367-2377
-
21
Fielding L P, Henson D E.
Multiple prognostic factors and outcome analysis in patients with cancer.
Cancer.
1993;
71
2426-2429
-
22
Fossa S D, Dearnaly D P, Law M, Gad J, Newling D W, Tveter K.
Prognostic factors in hormone-resistant cancer progressing of the prostate.
Ann Oncol.
1992;
3
361-366
-
23
Gao X, Porter A T, Grignon D J, Pontes J E, Honn K V.
Diagnostic and Prognostic Markers for Human Prostate Cancer.
Prostate.
1997;
31
264-281
-
24
George D J, Kantoff P W.
Prognostic indicators in hormone refractory prostate cancer.
Urol Clin North Am.
1999;
26
303-310
-
25 Gospodarowicz M K, Hermanek P, Henson D E. Introduction. In: Hermanek, Gospodarowicz, Henson et al. (Hrsg.). Prognostic Factors in Cancer Berlin: Springer 1995: 1-11
-
26
Gronberg H, Damber J E, Jonsson H, Lenner P.
Patient age as a prognostic factor in prostate cancer.
J Urol.
1994;
152
892-895
-
27
Grossfeld G D, Stier D M, Flanders S G, Henning J M, Schonfeld W, Warolin K, Carroll P R.
Use of second treatment following definite therapy for prostate cancer: Date from the CaPSURE Database.
J Urol.
1998;
160
1398-1404
-
28
Hanash K A, Utz D C, Cook E N, Taylor W F, Titus J L.
Carcinoma of the prostate. A 15-year follow up.
J Urol.
1972;
107
450-453
-
29
Harrell F E, Lee K L, Matchar D B, Reichert T A.
Regression models for prognostic prediction: advantages, problems, and suggested solutions.
Cancer Treat Rep.
1985;
69
1071-1077
-
30
Johansson J E, Adami O, Andersson S O, Bergstrom R, Krusemo U B, Kraaz W.
Natural history of localised prostate cancer. A population-based study in 223 untreated patients.
Lancet.
1988;
1
799-803
-
31
Johansson J E, Andersson S O, Holmberg L, Bergstrom R.
Prognostic factors in progression free survival and corrected survival in patients with advanced prostatic cancer: Results from a randomized study comprising 150 patients treated with orchiectomy and estrogens.
J Urol.
1991;
146
1327-1333
-
32
Jorgensen T, Kanagasingam Y, Kaalhus O, Tveter K J, Bryne M, Skjorten F, Berner A, Danielsen H E.
Prognostic factors in patients with metastatic (stage D2) prostate cancer: Experience from the Scandinavian Prostate Cancer Group Study 2.
J Urol.
1997;
158
164-170
-
33
Kabalin J N, McNeal J E, Johnstone I M, Stamey T A.
Serum prostate-specific antigen and the biologic progression of prostate cancer.
Urology.
1995;
46
65-70
-
34
Kattan M W, Eastham J A, Stapleton A MF, Wheeler T M, Scardino P T.
A preoperative nomogram for disease recurrence following radical prostatectomy for prostate cancer.
J Natl Cancer Inst.
1998;
90
766-771
-
35
Keegan P E, Matthews J NS, Lunec J, Neal D E.
Statistical problems with ‘optimal’ thresholds in studies of new prognostic factors in urology.
Br J Urol.
2000;
85
392-397
-
36
Kleer E, Larson-Keller J J, Zincke H, Oesterling J E.
Ability of preoperative serum prostate-specific antigen value to predict pathologic stage and DNA ploidy.
Urology.
1993;
41
207-216
-
37
Lerner S E, Blute M L, Zincke H.
Risk Factors for Progression in Patients With Prostate Cancer Treated With Radical Prostatectomy.
Sem Urol Oncol.
1996;
14
12-21
-
38
Manyak M J, Javitt M C.
The role of computerized tomography, magnetic resonance imaging, Bone scan, and monoclonal antibody nuclear scan for prognosis prediction in prostate cancer.
Sem Urol Oncol.
1998;
16
145-152
-
39
McGuire W L.
Breast cancer prognostic factors: Evaluation guidelines.
J Natl Cancer Inst.
1991;
83
154-155
-
40
Montie J E.
Current prognostic factors for prostate carcinoma.
Cancer.
1996;
78
341-344
-
41
Murphy W M.
Prognostic Factors in the Pathological Assessment of Prostate Cancer.
Human Pathology.
1998;
29
427-429
-
42
O'Dowd G J, Veltri R W, Orozco R, Miller M C, Oesterling J E.
Update on the appropriate staging evaluation for newly diagnosed prostate cancer.
J Urol.
1997;
158
687-698
-
43
Oefelein M G, Grayhack J T, McVary K T.
Survival after radical retropubic prostatectomy of men with clinically localized highgrade carcinoma of the prostate.
Cancer.
1995;
76
2535-2542
-
44
Palmberg Ch, Koivisto P, Visakorpi T, Tammela T LJ.
PDA decline is an independent prognostic marker in hormonally treated prostate cancer.
Eur Urol.
1999;
36
191-196
-
45
Partin A W, Kattan M W, Subong E NP, Walsh P C, Wojno K J, Oesterling J E, Scardino P T, Pearson J D.
Combination of prostate-specific antigen, clinical stage, and Gleason score to predict pathological stage of localized prostate cancer.
JAMA.
1997;
277
1445-1451
-
46
Reynard J M, Peters T L, Gilla H D.
PSA and prognosis in patients with metastatic prostatic cancer: A multivariate analysis of prostate cancer mortality.
Br J Urol.
1995;
75
507-515
-
47
Riedl C R, Hübner W A, Mossig H, Ogris E, Pflueger H.
Prognostic value of prostatic-specific antigen minimum after orchidectomy in patients with stage C and D prostatic carcinoma.
B J Urol.
1995;
76
34-40
-
48
Simon R, Altman D G.
Statistical aspects of prognostic factor studies in oncology.
Br J Cancer.
1994;
69
979-985
-
49
Smith D C, Dunn R L, Strawderman M S, Pienta K J.
Change in serum prostate-specific antigen as a marker of response to cytotoxic therapy for hormone-refractory prostate cancer.
J Clin Oncol.
1998;
16
1835-1843
-
50
Smith J A.
Stage T1c prostate cancer: Perspectives on clinical management.
Sem Urol Oncol.
1995;
13
238-244
-
51
Smith J R, Freije D, Carpten J D, Gronberg H, Xu J, Isaacs S D, Brownstein M J, Bova G S, Guo H, Bujnovszky P, Nusskern D R, Damber J E, Bergh A, Emanuelsson M, Kallioniemi O P, Walker-Daniels J, Bailey-Wilson J E, Beaty T H, Meyers D A, Walsh P C, Collins F S, Trent J M, Isaacs W B.
Major Susceptibility Locus for Prostate Cancer on Chromosome 1 Suggested by a Genome-Wide Search.
Science.
1996;
274
1371-1374
-
52
Van den Ouden D, Bentvelsen F M, Boevä E R, Schroeder F H.
Positive margins after radical prostatectomy: Correlation with local recurrence and distal progression.
Br J Urol.
1993;
72
489-493
-
53
Veltri R W, O'Dowd G J, Orozco R, Miller M C.
The role of biopsy pathology, quantitative nuclear morphometry, and biomarkers in the preoperative prediction of prostate cancer staging and prognosis.
Semin Urol Oncol.
1998;
16
106-117
-
54
Walsh P C.
Serum PSA after anatomic radical prostatectomy: the Johns Hopkins experience after 10 years.
Urol Clin North Am.
1993;
20
713-725
-
55
Waterbor J W, Bueschen A J.
Prostate Cancer screening (United States).
Cancer Causes Control.
1995;
6
267-274
PD Dr C G Fischer
Urologische KlinikJustus-Liebig Universität
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