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Aktuelle Urol 2001; 32(1): 3-10
DOI: 10.1055/s-2001-10742
ÜBERSICHT
Georg Thieme Verlag Stuttgart · New York

Prognosefaktoren des Prostatakarzinoms

Prognostic Factors in Prostate CancerC. G. Fischer1 , J. E. Altwein2 , H. J. Luboldt3
  • 1Urologische Universitätsklinik Gießen
  • 2Urologische Abteilung, Krankenhaus der Barmherzigen Brüder München
  • 3Urologische Universitätsklinik Essen
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Publikationsverlauf

Publikationsdatum:
31. Dezember 2001 (online)

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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

Literatur

  • 1 Aaltomaa S, Eskelinen M, Lipponen P. Expression of Cyclin A and D Proteins in Prostate Cancer and Their Relation to Clinopathological Variables and Patient Survival.  The Prostate. 1999;  38 175-182
    CrossrefPubMedGoogle Scholar
  • 2 Bauer J J, Connelly R R, Sesterhenn I A, Bettencourt M C, McLeod D G, Srivastava S, Moul J W. Biostatistical modeling using traditional variables and genetic biomarkers for predicting the risk of prostate carcinoma recurrence after radical prostatectomy.  Cancer. 1997;  79 952-962
    CrossrefPubMedGoogle Scholar
  • 3 Bostwick D G. Gleason Grading of Prostatic Needle Biopsies.  Am J Surg Pathol. 1994;  18 796-803
    CrossrefPubMedGoogle Scholar
  • 4 Boyle P. Epidemiologie des Prostatakarzinoms. In: Faul & Altwein (Hrsg.). Screening des Prostatakarzinoms Berlin: Springer 1995: 11-19
    Google Scholar
  • 5 Bundrick W S, Culkin D J, Mata J A, Zitman R I, Venable D D. Evaluation of the Current Indicence of Nodal Metastasis From Prostate Cancer.  J Surg Oncol. 1993;  52 269-271
    PubMedGoogle Scholar
  • 6 Burke H B, Henson D E. Criteria for prognostic factors and for an enhanced prognostic systern.  Cancer. 1993;  72 3131-3135
    PubMedGoogle Scholar
  • 7 Byar D P, Corle D K. Analysis of prognostic factors for prostate cancer in the VACURG studies. In: Denis et al. (Hrsg.). Controlled Clinical Trials in Urologic Oncology New York: Raven 1984: 147-169
    Google Scholar
  • 8 Cheng W S, Frydenberg M, Bergstralh E J, Larson-Keller J J, Zincke H. Radical prostatectomy for pathologic stage c prostate cancer: Influence of pathologic variables and adjuvant treatment on disease outcome.  Urology. 1993;  42 283-291
    CrossrefPubMedGoogle Scholar
  • 9 Chodak G W, Thisted R A, Gerber G S, Johansson J E, Adolfsson J, Jones G W, Chisholm G D, Moskovitz B, Livne P M, Warner J. Results of conservative management of clinically localized prostate cancer.  N Engl J Med. 1994;  330 242-248
    CrossrefPubMedGoogle Scholar
  • 10 Connolly J A, Shinohara K, Presti J C, Carroll P R. Local recurrence after radical prostatectomy: Characteristics in size, location and relationship to PSA and surgical margins.  Urology. 1996;  47 225-231
    CrossrefPubMedGoogle Scholar
  • 11 D'Amico A V, Desjardin A, Chung A, Chen M H, Schultz D, Whittington R, Malkowicz S B, Wein A, Tomaszewski J E, Renshaw A A, Loughlin K, Richie J P. Assessment of outcome prediction models for patients with localized prostate carcinoma managed with radical prostatectomy or external beam radiation therapy.  Cancer. 1998;  82 1887-1896
    CrossrefPubMedGoogle Scholar
  • 12 D'Amico A V, Whittington R, Malkowicz S B, Loughlin K, Schultz D, Schnall M, Tempany C M, Tomaszewski J E, Renshaw A, Wein A. An analysis of the time course of postoperative prostate-specific antigen failure in patients with positive surgical margins: Implications on the use of adjuvant therapy.  Urology. 1996;  47 538-547
    CrossrefPubMedGoogle Scholar
  • 13 Dawson N A. Apples and oranges: building a consensus for standardized eligibility criteria and end points in prostate cancer clinical trials.  J Clin Oncol. 1995;  16 3398-3405
    PubMedGoogle Scholar
  • 14 De la Taille A, Buttyan R, Benson M C, Katz A E. The role of tumor biomarkers as predictors of serum PSA recurrence after radical prostatectomy.  Semin Urol Oncol. 1998;  16 137-144
    PubMedGoogle Scholar
  • 15 De Voogt H J, Suciu S, Sylvester R, Pavone-Macaluso M, Smith P H, de Pauw M. Multivariate analysis of prognostic factors in patients with advanced prostatic cancer: results from 2 European Organization for Research on Treatment of Cancer trials.  J Urol. 1989;  141 883-888
    PubMedGoogle Scholar
  • 16 Duncan W, Catton C N, Warde P, Gospodarowicz M K, Munro A J, Lakier R, Simm J, Panzarella T. The influence of transurethral resection of prostate on prognosis of patients with adenocarcinoma of the prostate treated by radical radiotherapy.  Radiother Oncol. 1994;  31 41-50
    CrossrefPubMedGoogle Scholar
  • 17 Egawa S, Suyama K, Matsumoto K, Satoh T, Uchida T, Kuwao S, Koshiba K. Improved predictability of extracapsular extension and seminal vesicle involvement based on clinical and biopsy findings in prostate cancer in Japanese men.  Urology. 1998;  52 433-440
    CrossrefPubMedGoogle Scholar
  • 18 Eisenberger M A, Crawford E D, Wolf M, Blumenstein B, McLeod D G, Benson R, Dorr F A, Benson M, Spaulding J T. Prognostic Factors in Stage D2 Prostate Cancer; Important Implications for Future Trials: Results of a Cooperative Intergroup Study (INT.0036).  Semin Oncol. 1994;  21 613-619
    PubMedGoogle Scholar
  • 19 Epstein J I. Pathologic Evaluation of Prostatic Carcinoma: Critical Information for the Oncologist.  Oncology. 1996;  10 527-534
    PubMedGoogle Scholar
  • 20 Fielding L P, Fenoglio-Preiser C M, Freedman L S. The future of prognostic factors in outcome prediction for patients with cancer.  Cancer. 1992;  70 2367-2377
    PubMedGoogle Scholar
  • 21 Fielding L P, Henson D E. Multiple prognostic factors and outcome analysis in patients with cancer.  Cancer. 1993;  71 2426-2429
    PubMedGoogle Scholar
  • 22 Fossa S D, Dearnaly D P, Law M, Gad J, Newling D W, Tveter K. Prognostic factors in hormone-resistant cancer progressing of the prostate.  Ann Oncol. 1992;  3 361-366
    PubMedGoogle Scholar
  • 23 Gao X, Porter A T, Grignon D J, Pontes J E, Honn K V. Diagnostic and Prognostic Markers for Human Prostate Cancer.  Prostate. 1997;  31 264-281
    CrossrefPubMedGoogle Scholar
  • 24 George D J, Kantoff P W. Prognostic indicators in hormone refractory prostate cancer.  Urol Clin North Am. 1999;  26 303-310
    CrossrefPubMedGoogle Scholar
  • 25 Gospodarowicz M K, Hermanek P, Henson D E. Introduction. In: Hermanek, Gospodarowicz, Henson et al. (Hrsg.). Prognostic Factors in Cancer Berlin: Springer 1995: 1-11
    Google Scholar
  • 26 Gronberg H, Damber J E, Jonsson H, Lenner P. Patient age as a prognostic factor in prostate cancer.  J Urol. 1994;  152 892-895
    PubMedGoogle Scholar
  • 27 Grossfeld G D, Stier D M, Flanders S G, Henning J M, Schonfeld W, Warolin K, Carroll P R. Use of second treatment following definite therapy for prostate cancer: Date from the CaPSURE Database.  J Urol. 1998;  160 1398-1404
    PubMedGoogle Scholar
  • 28 Hanash K A, Utz D C, Cook E N, Taylor W F, Titus J L. Carcinoma of the prostate. A 15-year follow up.  J Urol. 1972;  107 450-453
    PubMedGoogle Scholar
  • 29 Harrell F E, Lee K L, Matchar D B, Reichert T A. Regression models for prognostic prediction: advantages, problems, and suggested solutions.  Cancer Treat Rep. 1985;  69 1071-1077
    PubMedGoogle Scholar
  • 30 Johansson J E, Adami O, Andersson S O, Bergstrom R, Krusemo U B, Kraaz W. Natural history of localised prostate cancer. A population-based study in 223 untreated patients.  Lancet. 1988;  1 799-803
    PubMedGoogle Scholar
  • 31 Johansson J E, Andersson S O, Holmberg L, Bergstrom R. Prognostic factors in progression free survival and corrected survival in patients with advanced prostatic cancer: Results from a randomized study comprising 150 patients treated with orchiectomy and estrogens.  J Urol. 1991;  146 1327-1333
    PubMedGoogle Scholar
  • 32 Jorgensen T, Kanagasingam Y, Kaalhus O, Tveter K J, Bryne M, Skjorten F, Berner A, Danielsen H E. Prognostic factors in patients with metastatic (stage D2) prostate cancer: Experience from the Scandinavian Prostate Cancer Group Study 2.  J Urol. 1997;  158 164-170
    CrossrefPubMedGoogle Scholar
  • 33 Kabalin J N, McNeal J E, Johnstone I M, Stamey T A. Serum prostate-specific antigen and the biologic progression of prostate cancer.  Urology. 1995;  46 65-70
    CrossrefPubMedGoogle Scholar
  • 34 Kattan M W, Eastham J A, Stapleton A MF, Wheeler T M, Scardino P T. A preoperative nomogram for disease recurrence following radical prostatectomy for prostate cancer.  J Natl Cancer Inst. 1998;  90 766-771
    CrossrefPubMedGoogle Scholar
  • 35 Keegan P E, Matthews J NS, Lunec J, Neal D E. Statistical problems with ‘optimal’ thresholds in studies of new prognostic factors in urology.  Br J Urol. 2000;  85 392-397
    PubMedGoogle Scholar
  • 36 Kleer E, Larson-Keller J J, Zincke H, Oesterling J E. Ability of preoperative serum prostate-specific antigen value to predict pathologic stage and DNA ploidy.  Urology. 1993;  41 207-216
    CrossrefPubMedGoogle Scholar
  • 37 Lerner S E, Blute M L, Zincke H. Risk Factors for Progression in Patients With Prostate Cancer Treated With Radical Prostatectomy.  Sem Urol Oncol. 1996;  14 12-21
    PubMedGoogle Scholar
  • 38 Manyak M J, Javitt M C. The role of computerized tomography, magnetic resonance imaging, Bone scan, and monoclonal antibody nuclear scan for prognosis prediction in prostate cancer.  Sem Urol Oncol. 1998;  16 145-152
    PubMedGoogle Scholar
  • 39 McGuire W L. Breast cancer prognostic factors: Evaluation guidelines.  J Natl Cancer Inst. 1991;  83 154-155
    CrossrefPubMedGoogle Scholar
  • 40 Montie J E. Current prognostic factors for prostate carcinoma.  Cancer. 1996;  78 341-344
    CrossrefPubMedGoogle Scholar
  • 41 Murphy W M. Prognostic Factors in the Pathological Assessment of Prostate Cancer.  Human Pathology. 1998;  29 427-429
    CrossrefPubMedGoogle Scholar
  • 42 O'Dowd G J, Veltri R W, Orozco R, Miller M C, Oesterling J E. Update on the appropriate staging evaluation for newly diagnosed prostate cancer.  J Urol. 1997;  158 687-698
    PubMedGoogle Scholar
  • 43 Oefelein M G, Grayhack J T, McVary K T. Survival after radical retropubic prostatectomy of men with clinically localized highgrade carcinoma of the prostate.  Cancer. 1995;  76 2535-2542
    PubMedGoogle Scholar
  • 44 Palmberg Ch, Koivisto P, Visakorpi T, Tammela T LJ. PDA decline is an independent prognostic marker in hormonally treated prostate cancer.  Eur Urol. 1999;  36 191-196
    CrossrefPubMedGoogle Scholar
  • 45 Partin A W, Kattan M W, Subong E NP, Walsh P C, Wojno K J, Oesterling J E, Scardino P T, Pearson J D. Combination of prostate-specific antigen, clinical stage, and Gleason score to predict pathological stage of localized prostate cancer.  JAMA. 1997;  277 1445-1451
    CrossrefPubMedGoogle Scholar
  • 46 Reynard J M, Peters T L, Gilla H D. PSA and prognosis in patients with metastatic prostatic cancer: A multivariate analysis of prostate cancer mortality.  Br J Urol. 1995;  75 507-515
    PubMedGoogle Scholar
  • 47 Riedl C R, Hübner W A, Mossig H, Ogris E, Pflueger H. Prognostic value of prostatic-specific antigen minimum after orchidectomy in patients with stage C and D prostatic carcinoma.  B J Urol. 1995;  76 34-40
    PubMedGoogle Scholar
  • 48 Simon R, Altman D G. Statistical aspects of prognostic factor studies in oncology.  Br J Cancer. 1994;  69 979-985
    CrossrefPubMedGoogle Scholar
  • 49 Smith D C, Dunn R L, Strawderman M S, Pienta K J. Change in serum prostate-specific antigen as a marker of response to cytotoxic therapy for hormone-refractory prostate cancer.  J Clin Oncol. 1998;  16 1835-1843
    PubMedGoogle Scholar
  • 50 Smith J A. Stage T1c prostate cancer: Perspectives on clinical management.  Sem Urol Oncol. 1995;  13 238-244
    PubMedGoogle Scholar
  • 51 Smith J R, Freije D, Carpten J D, Gronberg H, Xu J, Isaacs S D, Brownstein M J, Bova G S, Guo H, Bujnovszky P, Nusskern D R, Damber J E, Bergh A, Emanuelsson M, Kallioniemi O P, Walker-Daniels J, Bailey-Wilson J E, Beaty T H, Meyers D A, Walsh P C, Collins F S, Trent J M, Isaacs W B. Major Susceptibility Locus for Prostate Cancer on Chromosome 1 Suggested by a Genome-Wide Search.  Science. 1996;  274 1371-1374
    CrossrefPubMedGoogle Scholar
  • 52 Van den Ouden D, Bentvelsen F M, Boevä E R, Schroeder F H. Positive margins after radical prostatectomy: Correlation with local recurrence and distal progression.  Br J Urol. 1993;  72 489-493
    PubMedGoogle Scholar
  • 53 Veltri R W, O'Dowd G J, Orozco R, Miller M C. The role of biopsy pathology, quantitative nuclear morphometry, and biomarkers in the preoperative prediction of prostate cancer staging and prognosis.  Semin Urol Oncol. 1998;  16 106-117
    PubMedGoogle Scholar
  • 54 Walsh P C. Serum PSA after anatomic radical prostatectomy: the Johns Hopkins experience after 10 years.  Urol Clin North Am. 1993;  20 713-725
    PubMedGoogle Scholar
  • 55 Waterbor J W, Bueschen A J. Prostate Cancer screening (United States).  Cancer Causes Control. 1995;  6 267-274
    CrossrefPubMedGoogle Scholar

PD Dr C G Fischer

Urologische KlinikJustus-Liebig Universität

Klinikstr. 2935385 Gießen

Telefon: Tel. 0641-99-44501

Fax: Fax 0641-99-44509

eMail: E-mail: claus.fischer@chiru.med.uni-giessen.de

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