Zusammenfassung
Es gibt gute Gründe, nicht jedes neu entdeckte Prostatakarzinom sofort kurativ zu behandeln, weil die PSA-gestützte Früherkennung Überdiagnosen hervor bringt. Dieser Entwicklung tragen die neuen internationalen Leitlinien Rechnung, indem sie die Aktive Überwachung (Active Surveillance, AS) als gleichberechtigte Behandlungsoption für Tumoren mit geringem Risikoprofil empfehlen. Die gesicherten Daten über den natürlichen Krankheitsverlauf legen nahe, dass nur wenige Patienten mit lokal begrenzten Tumoren von einer kurativen Therapie profitieren. In der Literatur sind bis heute 6 AS-Serien mit über 2000 Patienten dokumentiert, bei 200 von ihnen beträgt das Follow-up mehr als 10 Jahre. Das tumorspezifische Überleben liegt bei 99–100 %, es gibt keinen Hinweis auf einen zu spät erkannten Progress. Die Erfolgsraten hinsichtlich Rezidiven sowie die pathohistologischen Befunde nach verzögertem Eingriff sind denen der sofortigen Intervention vergleichbar. Damit ist AS bei einer definierten Patientenklientel, für die eine kurative Therapie bei hohem Risiko nur geringen Nutzen bringt, eine sichere Therapieoption.
Abstract
For good reasons, newly detected prostate cancer must not necessarily be treated with curative intent: Prostate-specific antigen screening leads to overdiagnosis in 54 %. Current international guidelines on the treatment of prostate cancer take this development into account by recommending “active surveillance” (AS) as an equitable treatment option for low-risk prostate cancer. Data on the natural history of prostate cancer indicates that only few men with localised prostate cancer profit from active therapy. Currently, there are 6 series on AS with more than 2000 patients documented in the literature, 200 of them having a follow-up of ten years or more. Disease-specific survival is 99–100 %, and there is no hint at that progression was detected too late for effective treatment. The rates of biochemical recurrence and pathohistological findings of deferred treatment compare well with those of immediate intervention. Thus AS is a safe treatment option for a well-defined patient cohort that has only a small chance of benefit but a high risk of harm from curative treatment.
Schlüsselwörter
lokal begrenztes Prostatakarzinom - active surveillance - PSA-gestützte Früherkennung - Übertherapie
Key words
localised prostate cancer - active surveillance - PSA screening - overtreatment
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Prof. Dr. L. Weißbach
Stiftung Männergesundheit
Reinhardtstr. 2
10117 Berlin
eMail: weissbach@stiftung-maennergesundheit.de
