Krebskontrolle im Fokus – Einblicke und Ausblicke rund um die fokale Therapie des Prostatakrebses

Zusammenfassung

Im Spannungsfeld zwischen Ganzdrüsenstandardtherapien auf der einen und aktiver Überwachung auf der anderen Seite suchen Betroffene bei Prostatakrebs seit einigen Jahren nach wenig invasiven Alternativen. Insbesondere wird schon lange die Möglichkeit hinterfragt, ob nicht bei begrenzten Risikosituationen nur eine Behandlung des Tumors selbst unter Schonung des Restorgans möglich wäre. Der vorliegende Artikel stellt Argumente für und gegen eine fokale Behandlung gegenüber und erläutert technische Innovationen der letzten Jahre. Ein relativ hoher Anteil von durch eine Standardtherapie überbehandelten Patienten in der Niedrigrisiko-Situation auf der einen Seite und eine wesentlich verbesserte Technik in Diagnostik (v. a. mpMRT) und Therapie sind wesentliche Argumente, die nach Ansicht der Autoren zu einer Verschiebung vom Konzept der vollständigen Eradikation des Tumors unter Inkaufnahme von Nebenwirkungen hin zur ausreichend effektiven lokalen Tumorkontrolle durch eine fokale Behandlung mit besserem Erhalt der Lebensqualität in geeigneten Fällen führen wird.

Abstract

Faced with the dilemma of choosing between the extremes of standard whole gland therapy and active surveillance, those affected by prostate cancer have recently been on the lookout for less invasive alternatives. Particularly the question of whether it would be possible in low risk cancer to treat only the tumour itself while sparing the organ has long been considered. This article discusses the pros and cons of focal treatment and elucidates the latest innovative technologies. High overtreatment rates in low-risk patients submitted to standard therapy and considerable technological advances in diagnosis (particularly multiparametric MRI) and therapy are regarded by the authors as key arguments for abandoning complete tumour eradication with its side effects in favour of sufficient local cancer control by focal treatment with better preserved quality of life in suitable cases.

Schlüsselwörter

Niedrigrisikoprostatakarzinom - Gleason-Klassifikation - mpMRT - fokale Therapie - Rezidivtherapie

Key words

low-risk prostate cancer - Gleason grading system - multiparametric MRI - focal therapy - relapse treatment

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