Die perkutane Strahlentherapie als primäre Option der Therapie des lokal begrenzten Prostatakarzinoms

Zusammenfassung

Zur Behandlung des lokal begrenzten Prostatakarzinoms (PCa) werden die radikale Prostatektomie (RP), perkutane Strahlentherapie (RT), die permanente Seed-Implantation (PSI) oder die Active Surveillance (AS) als kurative Therapie eingesetzt. Unter Berücksichtigung der aktuellen deutschen S3-Leitlinie und der EAU-Guideline fassen wir das stadienabhängige Prozedere aus der Sicht der Strahlentherapie zusammen.

Beim lokal begrenzten niedrig-Risisko PCa ist bisher nicht geklärt, welche Behandlung die besten Resultate erbringt, wenn Heilungschance, Nebenwirkungsrisiko und Patientenwünsche berücksichtigt werden. Für diese Patientengruppe werden in der PREFERE Studie die RP, RT, PSI und AS vergleichend untersucht.

Beim PCa mit intermediärem oder mit hohem Risiko-Profil sind die kombinierte RT+hormonelle Behandlung (HT) oder die RP indiziert. Mit der frühen Salvage-RT, bei einem PSA unter 0,5 ng/ml, besteht nach post-RP biochemischem Rezidiv eine zweite Heilungschance.

Abstract

For localized prostate cancer (PCa), radical prostatectomy (RP), external-beam radiotherapy (RT), permanent seed implantation (PSI) or active surveillance (AS) are curative treatment options. Referring to the German S3-Guideline and the EAU-Guideline, we summarize stage-specific procedures from the perspective of radiotherapy.

For low-risk localized prostate cancer, it is not clear which treatment gives the best results if cure rates, risk of side effects and patients‘ preferences are taken into account. For these patients, the PREFERE trial will compare RP, RT, PSI and AS.

For PCa with intermediate or high-risk profile, combined RT and hormonal treatment or RP are indicated. Early salvage radiotherapy at a PSA below 0.5 ng/ml offers a second chance of cure in case of post-RP biochemical recurrence.

Key words

localized prostate cancer - stage specific treatment - definitive radiotherapy - adjuvant radiotherapy - salvage radiotherapy

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