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
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PD Dr C G Fischer
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