Das lokale Rezidiv nach radikaler Prostatektomie

Zusammenfassung

Einleitung: Die Diagnose eines lokalen Rezidivs (LR) nach radikaler Prostatektomie (RP) muss frühzeitig gestellt werden. Idealerweise sollte das Serum PSA < 1,5 ng/ml betragen [1]. Die Schwierigkeit bei der frühzeitigen Differenzierung zwischen lokalem und systemischem Rezidiv führt zu Problemen bei der Therapie. Material und Methode: Wir führten in einer prospektiven Untersuchung bei 33 Patienten mit postoperativem PSA-Anstieg nach Ausschluss einer Fernmetastasierung eine TRUS-gesteuerte Anastomosenbiopsie durch. Ergebnisse: Bei 22/33 Patienten (67 %) wurde in der Biopsie ein LR diagnostiziert. Bei 12 Patienten (56 %) konnte im TRUS ein hyperechogenes, tumorsuspektes Areal (n = 1), oder eine tumoröse Raumforderung (n = 11) festgestellt werden. Das Serum-PSA vor Bestrahlung war bei 10 Patienten ≤ 2,5 ng/ml und entsprach damit den Kriterien einer frühzeitigen Bestrahlung. In beiden Patientengruppen (LR+; LR-) bestand statistisch kein signifikanter Unterschied bei den histopathologischen Parametern der Prostatektomiepräparate (Tumorstadium, Absetzungsrand und Malignitätsgrad), dem Serum-PSA (vor RP u. vor Biopsie) und beim PSA-Nadir. 20/22 Patienten mit LR wurden bestrahlt. Die Gesamtstrahlendosis betrug 50 - 66 Gray (Gy). Eine komplette Tumorremission (PSA < 0,1 ng/ml) konnte bei 4 Patienten (CR = 24 %) erreicht werden. Die Dauer der kompletten Tumorremission lag bei 12, 14, 16 und 18 Monaten ( 15 Monate). Schlussfolgerung: Verbindliche Therapieempfehlungen sind dzt. weder auf Basis der Literatur noch unseres Kollektivs möglich. Eine frühzeitige Behandlung sollte durch den histologischen Nachweis des Lokalrezidivs abgesichert werden.

Abstract

Introduction: In patients with local failure and absence of distant metastases after radical prostatectomy radiotherapy (RT) should be initiated as early as possible, that is, at a serum-PSA level not greater than 1.5 ng/ml. Early discrimination between local and distant recurrence is difficult. PSA-relapse presents a therapeutic dilemma. Material and methods: A prospective investigation of TRUS-guided anastomosis biopsy included 33 patients referred to us for further evaluation and treatment, who displayed rising PSA levels after radical prostatectomy, but no evidence of distant metastases. Results: In 22/33 patients (67 %) a recurrent tumor was confirmed by needle biopsy. On TRUS, 12 of the 22 (56 %) showed a suspicious accumulation of hyperechoic tissue (n = 1) or a well circumscribed tumor (n = 11). Pre-RT serum PSA level was ≤ 2.5 ng/ml in 10 patients, which appears to be the upper limit for optimal RT. There was no difference in preoperative and pre-biopsy PSA levels, tumor category, tumor grade and margin status of the prostatectomy specimens in the two patient groups. RT was performed in 20/22 patients. Complete remission (PSA < 0,1 ng/ml) occured in 4 patients (CR = 24 %), with a duration of 12, 14, 16 and 18 months (mean 15 months). Conclusions: Conclusive therapy strategies cannot be presented based on the present literature or our small collective. If, however, early radiotherapy is performed. histological confirmation of local recurrence is recommended.

Prostatakarzinom - Prostatektomie - lokales Rezidiv

Prostate cancer - Prostatectomy - Local recurrence

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