Ist das Testosteron-Management beim fortgeschrittenen hormonsensitiven Prostatakarzinom zeitgemäß?

Zusammenfassung

Die hormonablative Therapie (ADT) ist beim fortgeschrittenen oder metastasierten Prostatakarzinom Standard. Hier wird sie entweder allein oder in Kombination mit weiteren Verfahren und Substanzen eingesetzt. Der Testosteron-Zielwert von < 50 ng/dl bzw. < 1.7 nmol/l wurde vor mehr als 40 Jahren willkürlich und sowie aufgrund, aus heutiger Sicht unsensibleren Messmethoden definiert. Seitdem sind immer mehr Daten generiert worden, die nahelegen, dass bei einem Testosteronwert < 20 ng/dl die Progression zum kastrationsresistenten Prostatakarzinom verzögert wird. Obwohl eine Absenkung des Zielwerts vielfach schon gefordert wird, hat dies noch keinen Eingang in die Praxis gefunden. Die Messung des Testosteronwerts zur Kontrolle des Ansprechens auf eine Hormonablation gehört bisher nicht zu den regulären Kontrolluntersuchungen. Auch in nationalen und internationalen Leitlinien gibt es hierzu keine konkreten Empfehlungen. Auf Basis der zunehmenden Evidenz rückt die Frage nach der klinischen Relevanz des Testosteron-Managements während der ADT immer stärker in den Fokus. Die aktuelle Datenlage hierzu soll in der vorliegenden Arbeit dargestellt werden.

Abstract

Androgen-deprivation therapy (ADT) is the standard therapy used for advanced or metastatic prostate cancer, either alone or in association with additional procedures and substances. The optimum value of testosterone postulated more than 40 years ago was arbitrarily set to be < 50 ng/dL or < 1.7 nmol/L and, from todayʼs perspective, was defined by more insensitive measurement methods. Since then, more and more data has been generated, suggesting that a value of < 20 ng/dL would be prognostically relevant. Yet no guideline has been changed so far despite the call for lowering the target value. Measuring testosterone to evaluate the response to androgen suppression is not yet established in clinical routine. There are no specific recommendations in national and international guidelines. Based on the evolving evidence, the question about testosterone management during ADT is gaining importance. The current data is summarised in this paper.

Schlüsselwörter

Monitoring - Testosteron - Prognose - Androgendeprivation - fortgeschrittenes Prostatakarzinom

Keywords

advanced prostate cancer - follow-up - androgen deprivation therapy - monitoring

Publication History

Received: 02 March 2021

Accepted after revision: 30 June 2021

Article published online:
23 September 2021

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