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
Literatur
-
1
Gann P H, Hennekens C H, Stampfer M J.
A prospective evaluation of plasma prostate-specific antigen for detection of prostatic cancer.
JAMA.
1995;
273
289-294
-
2
Stenman U H, Hakama M, Knekt P, Aromaa A, Teppo L, Leinonen J.
Serum concentrations of prostate specific antigen and its complex with alpha 1-antichymotrypsin before diagnosis of prostate cancer.
Lancet.
1994;
344
1594-1598
-
3
Parkes C, Wald N J, Murphy P. et al .
Prospective observational study to assess value of prostate specifc antigen as screening test for prostate cancer.
Br Med J.
1995;
311
1340-1343
-
4
Rübben H, Schalkhauser K, Wolff J, Luboldt H J.
Deutsches Krebsgesellschaft e. V. German Cancer Society e. V. S3 guideline for PSA determination in diagnosis of prostatic carcinoma.
Onkologie.
2003 Feb;
26 (1)
88-89
-
5
Kirby R, Kirny M, Feneley M, McNicholas T, McLean A, Webb J.
Screening for carcinoma of the prostate: a GP based study.
Br J Uro.
1994;
74
64-71
-
6
Schmid H, Altwein J E, Faul P, Wirth M.
Screening und Früherkennung des Prostatakarzinoms.
Dtsch Ärztebl.
1999;
96
12-A772 - 777
-
7 Schwartz F, Robra B. Stand und Perspektiven der Forschung zur Krebsfrüherkennung. In: Schwartz F, Badura B, Brecht J, Hofmann W, Jöckel K, Trojan A (Hrsg). Public health. Berlin, Heidelberg, New York: Springer 1996
-
8 Walsh P. The natural history of localized prostate cancer: a guide to therapy. In: Walsh P, Retik A, Stamey T, Vaughan EJ (eds.). Campbell"s Urology. 7th. ed. Philadelphia: Saunders 1997: 2539-2564
-
9
Catalona W, Richie J, Ahmann F, Hudson M, Scardino P, Flanigan R, de Kernion J, Ratliff T, Kavoussi L, Dalkin B, Waters W, MacFarlane M, Southwick P.
Comparison of digital rectal examination and serum prostate specific antigen in the early detection of prostate cancer: results of a multicenter clinical trial of 6,630 men.
J Urol.
1994;
151
1283-1290
-
10
Lubold H, Rübben J.
PSA-Früherkennung des Prostatakarzinoms.
Urologe [A].
2000;
39
22-26
-
11
Oliver S E, Gunnell D, Donovan J L.
Comparison of trends in prostate-cancer mortality in England and Wales and the USA.
Lancet.
2000;
355
1788-1789
-
12
Visser O, Coebergh J WW, Schouten L J, Dijck J AAM van.
Incidence of Cancer in the Netherlands 1997. Utrecht: Vereniging Van Integrale Kankercentral, 2001 7 Greenlee RT, Hill-Harmon MB, Thun M. Cancer statistics.
CA Cancer J Clin.
2001;
51
15-36
-
13
Greenlee R T, Hill-Harmon M B, Thun M.
Cancer statistics.
CA Cancer J Clin.
2001;
51
15-36
-
14
Bartsch G, Horninger W, Klocker H. et al .
Decrease in prostate cancer mortality following introduction of prostate specifc antigen (PSA) screening in the federal state of Tyrol, Austria.
J Urol.
2000;
163 (Suppl. 4)
88-A387
-
15
Labrie F, Candas B, Dupont A. et al .
Screening decreases prostate cancer death. first analysis of the 1988 Quebec prospective randomized controlled trial.
Prostate.
1999;
38
83-91
-
16
Alexander F E.
Screening decreases prostate cancer death. First analysis of the 1988 Quebec prospective randomized controlled trial.
Prostate.
1999;
40
135-136
-
17
Boer R, Schröder F H.
Quebec randomized controlled trial on prostate cancer screening shows no evidence for mortality reduction [letter].
Prostate.
1999;
40
130-134
-
18
Hankey B F, Feuer E J, Clegg L X. et al .
Cancer Surveillance Series: Interpreting trends in prostate cancer - Part I. Evidence of the effects of screening in recent prostate cancer incidence, mortality, and survival rates.
J Natl Cancer Inst.
1999;
91
1017-1024
-
19
Etzioni R, Legler J M, Feuer E J, Merrill R M, Cronin K A, Hankey B F.
Cancer surveillance series: interpreting trends in prostate cancer - part III. Quantifying the link between population prostate-specific antigen testing and recent declines in prostate cancer mortality.
J Natl Cancer Inst.
1999;
91
1033-1039
-
20 Stanford J L, Stephenson R A, Coyle L M. et al .Prostate cancer trends, 1973 - 95. SEER Program National Cancer Institute. National Cancer Institute Monograph 1998 (http://www.seer.img.nci.nih.gov). 1998
-
21
Etzioni R, Penson D F, Legler J M, di Tommaso D, Boer R, Gann P H, Feuer E J.
Overdiagnosis due to prostate-specific antigen screening: lessons from U.S. prostate cancer incidence trends.
J Natl Cancer Inst 2002 Jul.
3;
94 (13)
981-990
-
22
Walsh P C.
Comment on: Overdiagnosis due to prostate-specific antigen screening: lessons from U.S. prostate cancer incidence trends.
J Natl Cancer Inst/J Urol.
2002 Jul 3/2003;
94 (13)/170 (1)
981-990; 313 - 314
-
23
Madalinska J B, Essink-Bot M L, de Koning H J, Kirkels W J, Maas P J van der, Schröder F H.
Health-related quality-of-life effects of radical prostatectomy and primary radiotherapy for screen-detected or clinically diagnosed localized prostate cancer.
J Clin Oncol.
2001;
19
1612-1628
-
24
Litwin M S, Fitzpatrick J M, Fossa S D, Newling D WW.
Defining an international research agenda for quality of life in men with prostate cancer.
Prostate.
1999;
41
58-67
-
25
Beemsterboer P M, de Koning H J, Birnie E, Maas P J van der, Schröder F H.
Advanced prostate cancer. Course, care, and cost implications.
Prostate.
1999;
40
97-104
-
26
Carter H B, Pearson J D, Metter E J. et al .
Longitudinal evaluation of prostate-specific antigen levels in men with and without prostate disease.
JAMA.
1992;
267
2215-2220
-
27
Albertsen P C, Fryback D G, Storer B E, Kolon T F, Fine J.
Long-term survival among men with conservatively treated localized prostate cancer.
JAMA.
1995;
274
626-631
-
28
Albertsen P C, Hanley J A, Gleason D F, Barry M J.
Competing risk analysis of men aged 55 - 74 years at diagnosis managed conservatively for clinically localized prostate cancer.
JAMA.
1998;
280
975-980
-
29
Epstein J I, Walsh P C, Carmichael M, Brendler C B.
Pathologic and clinical findings to predict tumor extent of nonpalpable (stage T1c) prostate cancer.
JAMA.
1994;
271
368-374
-
30
Schröder F H, Wildhagen M F. Rotterdam Study Group of the “European Randomised Study of Screening for Prostate Cancer” (ERSPC) .
Screening for prostate cancer: evidence and perspectives.
BJU Int.
2001 Nov;
88 (8)
811-817
-
31
Catalona W J, Miller D R, Kavoussi L R.
Intermediate-term survival results in clinically understaged prostate cancer patients following radical prostatectomy.
J Urol.
1988;
140
540-543
-
32
Kranse R, Beemsterboer P, Rietbergen J, Habbema D, Hugosson J, Schröder F H.
Predictors for biopsy outcome in the European Randomized Study of Screening for Prostate Cancer (Rotterdam region).
Prostate.
1999;
39
316-322
-
33
Hoedemaeker R F, Rietbergen J B, Kranse R, Kwast T H van der, Schröder F H.
Comparison of pathologic characteristics of T1 c and non-T1 c cancers detected in a population-based screening study, the European Randomized Study of Screening for Prostate Cancer.
World J Urol.
1997;
15
339-345
-
34
Schröder F H, Maas P van der, Beemsterboer P. et al .
Evaluation of the digital rectal examination as a screening test for prostate cancer. Rotterdam section of the European Randomized Study of Screening for Prostate Cancer.
J Natl Cancer Inst.
1998;
90
1817-1823
-
35
Schröder F H, Cruijsen-Koeter I van der, de Koning H J, Vis A N, Hoedemaeker R F, Kranse R.
Prostate cancer detection at low prostate specific antigen.
J Urol.
2000;
163
806-812
-
36
Schröder F H, Roobol-Bouts M, Vis A N, Kwast T van der, Kranse R.
Prostate-specific antigen-based early detection of prostate cancer - validation of screening without rectal examination.
Urology.
2001;
57
83-90
-
37
Eskew L A, Bare R L, McCullough D L.
Systematic 5 region prostate biopsy is superior to sextant method for diagnosing carcinoma of the prostate.
J Urol.
1997;
157
199-202
-
38
Davidson P JT, Hop W, Kurth K H. et al .
Progression in untreated carcinoma of the prostate metastatic to regional lymph nodes (stage T0 - 4, N1 - 3,Mo,D1).
J Urol.
1995;
154
2118-2122
-
39
Klotz L, Choo R, De Boer G. et al .
PSA doubling time of prostate carcinoma managed with watchful observation alone.
J Urol.
2000;
163 (Suppl. 4)
58-A251
-
40 American Urological Society .Executive Committee Report. Baltimore: American Urological Association 1992
-
41 Weymayr C, Koch K. Mythos Krebsvorsorge, Schaden und Nutzen der Früherkennung, 1th. ed. Frankfurt a. M.: Eichborn 2003: 141-156
-
42
Fornara P.
„Stimmungsmache”. Die Deutsche Gesellschaft für Urologie ist der Auffassung, dass die Vorteile der PSA-Untersuchung die Nachteile bei weitem überwiegen.
Dtsch Ärztebl.
2003;
100
42-A-2703
-
43
Schröder F H, Denis L J, Roobol M.
The Story of the European Randomized Study of Screening for Prostate Cancer.
BJU Int.
2003;
92 (Suppl. 2)
1-13
-
44
Auvinen A, Hugosson J.
The rationale for the ERSPC trial, will it improve the knowledge base on prostate cancer screening?.
BJU Int.
2003;
92 (Suppl. 2)
14-16
-
45
Nelen V, Thys G, Neels H, Neetens I, Coebergh J W, Dourcy-Belle-Rose B, Denis L.
ERSPC, features and preliminary results from the Antwerp study centre.
BJU Int.
2003;
92 (Suppl. 2)
17-21
-
46
Finne P, Stenman U H, Määttänen T, Mäkinen T, Tammela T LJ, Martikainen P, Ruutu M, Ala-Opas M, Aro J, Karhunen P J, Lahtela J, Rissanen P, Juusela H, Hakama M, Auvinen A.
The Finnish trial of prostate cancer screening, where are we now?.
BJU Int.
2003;
92 (Suppl. 2)
22-26
-
47
Villers A, Malavaud B, Rebillard X, Bataille V, Iborra F.
ERSPC, features and preliminary results of France.
BJU Int.
2003;
92 (Suppl. 2)
27-29
-
48
Ciatto S, Gervasi G, Frullini P, Zendron P, Zappa M.
Specific features of the Italian section of the ERSPC.
BJU Int.
2003;
92 (Suppl. 2)
30-32
-
49
Berenguer A, Luján M, Páez A, Santonja C, Pascual T.
The Spanish Contribution to the European Randomized Study of Screening for Prostate Cancer.
BJU Int..
2003;
92 (Suppl. 2)
33-38
-
50
Hugosson J, Aus G, Bergdahl S, Fernlund P, Frösing R, Lodding P, Pihl C G, Lilja H.
Population-based screening for prostate cancer by measuring free and total serum prostate-specific antigen in Sweden.
BJU Int.
2003;
92 (Suppl. 2)
39-43
-
51
Kwiatkowski M, Huber A, Stamm B, Lehmann K, Wernli M, Häfeli A, Recker F.
Features and preliminary results of prostate cancer screening in Canton Aargau, Switzerland.
BJU Int.
2003;
92 (Suppl. 2)
44-47
-
52
Roobol M J, Kirkels W J, Schröder F H.
Features and preliminary results of the Dutch centre of the ERSPC (Rotterdam, the Netherlands).
BJU Int.
2003;
92 (Suppl. 2)
48-54
-
53
Smith P H.
The Data Morning Committee - Bridging the Gap Between Urology and Public Health Epidemiology.
BJU Int.
2003;
92 (Suppl. 2)
55-56
-
54
van der Kwast T H, Lopes C, Martikainen P M, Pihl C G, Santonja C, Neetens I, Di Lollo S, Hoedemaeker R F.
Report of the Pathology Committe, False-positive and False-negative Diagnoses of Prostate Cancer.
BJU Int.
2003;
92 /Suppl. 2)
62-65
-
55
De Koning H J, Blom J, Merkelbach J W, Raaijmakers R, Verhaegen H, van Vliet P, Nelen V, Coebergh J WW, Hermans A, Ciatto S, Mäkinen T.
Determing the cause of death in randomized screening trial(s) for prostate cancer.
BJU Int.
2003;
92 (Suppl. 2)
71-78
-
56
Ciatto S, Vis A, Finne P.
How to Improve the Specificity and Sensitivity of Biopsy Technique in Screening.
BJU Int.
2003;
92 (Suppl. 2)
79-83
-
57
Páez A, Luján M, Raaijmakers R, Berenguer A.
Four-year Prostate-Specific Antigen Progression in the non-Cancer Population of the European Randomized Study of Screening for Prostate Cancer.
BJU Int.
2003;
92 (Suppl. 2)
84-87
-
58
Van der Kwast T H, Roobol M J, Wildhagen M F, Martikainen P M, Määtänen L, Pihl C-G, Santonja C, Bubendorf L, Neetens I, di Lollo S, Hoedemaeker R F.
Consistency of Prostate Cancer Grading Results in Screened Populations Across Europe.
BJU Int.
2003;
92 (Suppl. 2)
88-91
Prof. Dr. Paolo Fornara
Klinik und Poliklinik für Urologie · Medizinische Fakultät, Martin-Luther-Universität Halle/Wittenberg
Ernst-Grube-Str. 40
06112 Halle/Saale
Phone: +49/345/5 57 14 46
Email: paolo.fornara@medizin.uni-halle.de
