Download PDF
Aktuelle Urol 2010; 41(4): 239-244
DOI: 10.1055/s-0030-1247461
Übersicht

© Georg Thieme Verlag KG Stuttgart ˙ New York

Aktive Überwachung des früh erkannten Prostatakarzinoms als Zukunftsstrategie

Active Surveillance for Screen-Detected Prostate Cancer – A Strategy for the Future?L. Weißbach1 , C. Schaefer1
  • 1Stiftung Männergesundheit
Further Information

Publication History

Publication Date:
26 July 2010 (online)

Also available at
    Permissions and Reprints

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

Literatur

  • 1 SEER .Cancer statistics.  http://seer.cancer.gov/statfacts/html/prost.html
    Google Scholar
  • 2 Tumorzentrum Brandenburg .Qualitätsbericht 2008.  http://www.tumorzentrum-brandenburg.de/pwp/(S(qr5ick3jxmbvwn55lsgifb45))/uploads/Sachbericht_2008%5B1%5D.pdf
    Google Scholar
  • 3 Parker C, Muston D, Melia J et al. A model of the natural history of screen-detected prostate cancer, and the effect of radical treatment on overall survival.  Br J Cancer. 2006;  94 1361-1368
    CrossrefPubMedGoogle Scholar
  • 4 Schröder F H. Screening for prostate cancer (PC) – an update on recent findings of the European Randomized Study of Screening for Prostate Cancer (ERSPC).  Urol Oncol. 2008;  26 533-541
    CrossrefPubMedGoogle Scholar
  • 5 Beske F, Katalinic A, Peters E et al. Morbiditätsprognose 2050. Ausgewählte Krankheiten für Deutschland, Brandenburg und Schleswig-Holstein. Schriftenreihe / Fritz Beske Institut für Gesundheits-System-Forschung Kiel; Bd. 114. Kiel 2009
    Google Scholar
  • 6 Klotz L, Zhang L, Lam A et al. Clinical results of long-term follow-up of a large, active surveillance cohort with localized prostate cancer.  J Clin Oncol. 2010;  28 126-131
    CrossrefPubMedGoogle Scholar
  • 7 van den Bergh R C, Roemeling S, Roobol M J et al. Outcomes of men with screen-detected prostate cancer eligible for active surveillance who were managed expectantly.  Eur Urol. 2009;  55 1-8
    CrossrefPubMedGoogle Scholar
  • 8 van As N J, Norman A R, Thomas K. Predicting the probability of deferred radical treatment for localised prostate cancer managed by active surveillance.  Eur Urol. 2008;  54 1297-1305
    CrossrefPubMedGoogle Scholar
  • 9 Soloway M S, Soloway C T, Williams S et al. Active surveillance; a reasonable management alternative for patients with prostate cancer: the Miami experience.  BJU Int. 2008;  101 165-169
    PubMedGoogle Scholar
  • 10 Carter H B, Kettermann A, Warlick C et al. Expectant management of prostate cancer with curative intent: an update of the Johns Hopkins experience.  J Urol. 2007;  178 2359-2364
    CrossrefPubMedGoogle Scholar
  • 11 Dall’Era M A, Konety B R, Cowan J E et al. Active surveillance for the management of prostate cancer in a contemporary cohort.  Cancer. 2008;  112 2664-2670
    CrossrefPubMedGoogle Scholar
  • 12 Khatami A, Kus G, Damber J E et al. PSA doubling time predicts the outcome after active surveillance in screening-detected prostate cancer: results from the European randomized study of screening for prostate cancer, Sweden section.  Int J Cancer. 2007;  120 170-174
    CrossrefPubMedGoogle Scholar
  • 13 Schröder F H, Hugosson J, Roobol M J et al. Screening and prostate-cancer mortality in a randomized European study.  N Engl J Med. 2009;  360 1320-1328
    CrossrefPubMedGoogle Scholar
  • 14 Steyerberg E W, Roobol M J, Kattan M W et al. Prediction of indolent prostate cancer: validation and updating of a prognostic nomogram.  J Urol. 2007;  177 107-112
    CrossrefPubMedGoogle Scholar
  • 15 Cooperberg M R, Broering J M, Kantoff P W et al. Contemporary trends in low risk prostate cancer: risk assessment and treatment.  J Urol. 2007;  178 (3 Pt 2) 14-19
    CrossrefPubMedGoogle Scholar
  • 16 Robert-Koch-Institut und die Gesellschaft der epidemiologischen Krebsregister in Deutschland e. V .Krebs in Deutschland 2003–2004. Häufigkeiten und Trends. 6. Überarbeitete Auflage. Berlin: Robert-Koch-Institut, Hrsg. und die Gesellschaft der epidemiologischen Krebsregister in Deutschland e. V., Hrsg.; 2008
    Google Scholar
  • 17 www.gbe-bund.de . Tabelle am 11.04.2010 23:31 Uhr erstellt
    Google Scholar
  • 18 Johansson J E. Expectant management of early stage prostatic cancer: Swedish experience.  J Urol. 1994;  152 (5 Pt 2) 1753-1756
    PubMedGoogle Scholar
  • 19 Duffield A S, Lee T K, Miyamoto H et al. Radical prostatectomy findings in patients in whom active surveillance of prostate cancer fails. Reply by authors.  J Urol. 2009;  182 2279
    CrossrefPubMedGoogle Scholar
  • 20 Bill-Axelson A, Holmberg L, Ruutu M et al. Radical prostatectomy versus watchful waiting in early prostate cancer.  N Engl J Med. 2005;  352 1977-1984
    CrossrefPubMedGoogle Scholar
  • 21 Bill-Axelson A, Holmberg L, Filén F et al. Radical prostatectomy versus watchful waiting in localized prostate cancer: the Scandinavian prostate cancer group-4 randomized trial.  J Natl Cancer Inst. 2008;  100 1144-1154
    CrossrefPubMedGoogle Scholar
  • 22 Suardi N, Briganti A, Gallina A et al. Testing the most stringent criteria for selection of candidates for active surveillance in patients with low-risk prostate cancer.  BJU Int. 2009;  ,  [Epub ahead of print]
    PubMedGoogle Scholar
  • 23 Duffield A S, Lee T K, Miyamoto H et al. Radical prostatectomy findings in patients in whom active surveillance of prostate cancer fails.  J Urol. 2009;  182 2274-2278
    CrossrefPubMedGoogle Scholar
  • 24 Thaxton C S, Loeb S, Roehl K A et al. Treatment outcomes of radical prostatectomy in potential candidates for 3 published active surveillance protocols.  Urology. 2010;  75 414-418
    CrossrefPubMedGoogle Scholar
  • 25 van den Bergh R C, Steyerberg E W, Khatami A et al. Is delayed radical prostatectomy in men with low-risk screen-detected prostate cancer associated with a higher risk of unfavorable outcomes?.  Cancer. 2010;  116 1281-1290
    CrossrefPubMedGoogle Scholar
  • 26 Shappley 3rd  W V, Kenfield S A, Kasperzyk J L et al. Prospective study of determinants and outcomes of deferred treatment or watchful waiting among men with prostate cancer in a nationwide cohort.  J Clin Oncol. 2009;  27 4980-4985
    CrossrefPubMedGoogle Scholar
  • 27 Graefen M. Abwarten beim PCa kann nachteilig sein.  Uro Forum. 2010;  2 29-30
    PubMedGoogle Scholar
  • 28 Litwin M S, Lubeck D P, Spitalny G M et al. Mental health in men treated for early stage prostate carcinoma: a posttreatment, longitudinal quality of life analysis from the Cancer of the Prostate Strategic Urologic Research Endeavor.  Cancer. 2002;  95 54-60
    CrossrefPubMedGoogle Scholar
  • 29 van den Bergh R C, Essink-Bot M L, Roobol M J et al. Do anxiety and distress increase during active surveillance for low risk prostate cancer?.  J Urol. 2010;  183 1786-1791
    CrossrefPubMedGoogle Scholar
  • 30 Steineck G, Helgesen F, Adolfsson J et al. Quality of life after radical prostatectomy or watchful waiting.  N Engl J Med. 2002;  347 790-796
    CrossrefPubMedGoogle Scholar
  • 31 Burnet K L, Parker C, Dearnaley D et al. Does active surveillance for men with localized prostate cancer carry psychological morbidity?.  BJU Int. 2007;  100 540-543
    CrossrefPubMedGoogle Scholar
  • 32 Fujita K, Landis P, McNeil B K et al. Serial prostate biopsies are associated with an increased risk of erectile dysfunction in men with prostate cancer on active surveillance.  J Urol. 2009;  182 2664-2669
    CrossrefPubMedGoogle Scholar
  • 33 Parker C. Editorial comment.  J Urol. 2008;  180 2429
    PubMedGoogle Scholar
  • 34 Harnden P, Naylor B, Shelley M D et al. The clinical management of patients with a small volume of prostatic cancer on biopsy: what are the risks of progression? A systematic review and meta-analysis.  Cancer. 2008;  112 971-981
    CrossrefPubMedGoogle Scholar
  • 35 Cooperberg M R, Broering J M, Carroll P R. Time trends and local variation in primary treatment of localized prostate cancer.  J Clin Oncol. 2010;  28 1117-1123
    CrossrefPubMedGoogle Scholar
  • 36 Stattin P, Holmberg E, Bratt O et al. Surveillance and deferred treatment for localized prostate cancer. Population based study in the National Prostate Cancer Register of Sweden.  J Urol. 2008;  180 2423-2429
    CrossrefPubMedGoogle Scholar
  • 37 Sengupta S, Blute M L, Bagniewski S M et al. After radical retropubic prostatectomy ‘insignificant’ prostate cancer has a risk of progression similar to low-risk ‘significant’ cancer.  BJU Int. 2008;  101 170-174
    CrossrefPubMedGoogle Scholar
  • 38 D’Amico A V, Chen M H, Roehl K A et al. Preoperative PSA velocity and the risk of death from prostate cancer after radical prostatectomy.  N Engl J Med. 2004;  351 125-135
    CrossrefPubMedGoogle Scholar
  • 39 Scheerer J, Kahabka P, Altwein J et al. Calculation of NNT for Treatment Decisions in Prostate Cancer.  BJU Int. 2010;  ,  (eingereicht)
    PubMedGoogle Scholar
  • 40 Zietman A. Evidence-based medicine, conscience-based medicine, and the management of low-risk prostate cancer.  J Clin Oncol. 2009;  27 4935-4936
    CrossrefPubMedGoogle Scholar
  • 41 Albertsen P C. Editorial Comment.  J Urol. 2000;  163 812
    PubMedGoogle Scholar
  • 42 Kakehi Y, Kamoto T, Shiraishi T et al. Prospective evaluation of selection criteria for active surveillance in Japanese patients with stage T1cN0M0 prostate cancer.  Jpn J Clin Oncol. 2008;  38 122-128
    CrossrefPubMedGoogle Scholar

Prof. Dr. L. Weißbach

Stiftung Männergesundheit

Reinhardtstr. 2

10117 Berlin

Email: weissbach@stiftung-maennergesundheit.de

    Thieme-connect
>