Prostatakarzinom - Diagnostik und Staging

Zusammenfassung

Das Prostatakarzinom ist in Deutschland die häufigste maligne Neoplasie beim Mann. Das primär eingesetzte bildgebende Verfahren ist der transrektale Ultraschall (TRUS). Zum histologischen Nachweis eines Prostatakarzinoms wird bei erhöhtem PSA-Wert eine systematische TRUS-gesteuerte, transrektale Biopsie der Prostata durchgeführt. Bei ein- oder mehrmaliger negativer Stanzbiopsie kann die Indikation für eine MRT mit einer kombinierten Endorektal-Körper-Phased-Array-Spule bei 1,5 Tesla gestellt werden. Die dynamische, kontrastmittelunterstützte MRT und die Protonenmagnetresonanzspektroskopie können in Kombination mit der konventionellen MRT den Nachweis des Prostatakarzinoms verbessern. Für das lokale Staging des Prostatakarzinoms ist die MRT besser geeignet als die digitale rektale Untersuchung und der transrektale Ultraschall, wobei die in der Literatur genannten Treffsicherheiten für diese Verfahren sehr unterschiedlich sind. Für den Nachweis von Knochenmetastasen ist aktuell die Knochenszintigraphie mit ^99mTc-Bisphosphonat die Methode der Wahl. Bessere Sensitivitäten konnten mit den neueren Verfahren wie der Ganzkörper-MRT und der PET mit den Tracern ¹⁸F-FDG, ¹¹C-Cholin und ¹¹C-Acetat erreicht werden.

Abstract

Prostate cancer is the most common malignancy of men in Germany. Transrectal ultrasound (TRUS) is the primary used imaging modality. Patients with elevated PSA levels undergo systematic TRUS-guided transrectal biopsy of the prostate for histologic confirmation of prostate cancer. Magnetic resonance imaging (MRI) using the combined endorectal body phased-array coil may be indicated in men with one or more negative prostate biopsies. The detection of prostate cancer by conventional MRI can be improved by an additional dynamic contrast-enhanced MR study and proton MR spectroscopy. Local staging of prostate cancer by MRI is more accurate compared with digital rectal examination and transrectal ultrasound. However, accuracies reported in the literature for these procedures vary widely. Bone scintigraphy with ^99mTc-bisphosphonate is currently the method of choice for the detection of bone metastases. However, more recent techniques such as whole-body MRI and PET using ¹⁸F-FDG, ¹¹C-choline or ¹¹C-acetate as tracers were found to have higher sensitivities.

Key words

Prostate cancer - TRUS - MRI - MRS - PET

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