PSA-gesteuerte Früherkennung des Prostatakarzinoms

Zusammenfassung

Die frühe Diagnose und die radikale Therapie des Prostatakarzinoms ist die einzige Chance auf Heilung. Die PSA-gesteuerte Früherkennung führt zu einer Vorverlegung des Diagnosezeitpunktes um 5 bis 10 Jahre [1] [2] [3]. Obgleich Früherkennungsmaßnahmen eine Verschiebung der Tumorstadien beim Diagnosezeitpunkt hin zu organbegrenzten Tumoren bewirkt und dies einen therapeutischen Vorteil darstellt, wird die Etablierung von Früherkennungsmaßnahmen weiterhin kontrovers diskutiert. Diese Diskussion findet ihre Ursache in dem unbestimmten Anteil an überdiagnostizierten Patienten durch flächendeckende Früherkennungsmaßnahmen sowie dem daraus resultierenden unklaren Risiko-/Nutzen-Gleichgewicht für den Patienten. Ob die krankheitsspezifische Mortalität des Prostatakarzinoms durch Früherkennungsmaßnahmen tatsächlich verringert werden kann, können nur Ergebnisse aus randomisierten Studien klären. Diese fehlen zur Zeit noch und stehen erst im Jahre 2005 bzw. 2008 zur Verfügung. Ein Ausweg kann nur eine umfassende individuelle Aufklärung des Patienten über die Wertigkeit der zur Verfügung stehenden Früherkennungsinstrumente, die daraus evtl. resultierenden notwendigen Folgeuntersuchungen, deren Risiko sowie gegebenenfalls notwendige therapeutische Konsequenzen und deren Risiko-/Nutzen-Profil sein [4]. Über den aktuellen Stand der European Randomized Study of Screening for Prostate Cancer” informiert F. H. Schröder im British Journal of Urology International im Dezember 2003.

Abstract

The early detection of prostate cancer and the aggressive treatment is the only chance for a cure. The use of PSA-related screening techniques accelerates the diagnosis of the disease by 5 - 10 years [1] [2] [3]. While such early detection regimens shift the stage at the time of detection towards locally confined disease, and while there is no doubt that early treatment is the only way of curing prostate cancer, the application of screening in practice and healthcare policy remains controversial because there are uncertainties about the degree of „over-diagnosis” which most probably results from screening and uncertainties about the risk-benefit balance. Randomized studies will show whether early detection of prostate cancer can reduce cancer-specific mortality. Conclusive data will not be available before 2005 respectively 2008. At that time, only the validated complied information about the risks and benefits of screening and about the possible therapeutic consequences may provide a way out of this current dilemma [4]. A synopsis of the (European Randomized Study of Screening for Prostate Cancer) was given by F. H. Schröder in the British Journal of Urology International, December 2003.

Schlüsselwörter

Prostatakarzinom - Früherkennung - prostataspezifisches Antigen

Key words

Prostate cancer - screening - prostate specific antigen

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