Die Behandlung des fortgeschrittenen, unheilbaren Prostatakarzinoms – Möglichkeiten einer medikamentösen und palliativen Therapie

Trotz technischer Fortschritte in der Behandlung des Prostatakarzinoms schreitet die Erkrankung in 27–54 % der Patienten innerhalb von 10 Jahren fort und bedarf einer medikamentösen, palliativen Therapie. Steigt das Prostataspezifische Antigen (PSA–Wert) nach der initialen Therapie durch Operation an, muss die Wahrscheinlichkeit eines lokalen Rezidivs gegenüber einer lymphogenen oder hämatogenen Metastasierung abegewogen werden, um die Rationale für eine sekundäre Radiatio der ehemalien Prostataloge abzuwägen. Die proliferative Wirkung des Testosterons auf die Prostatakarzinomzelle kann durch die Hormonsuppression auf hypophysärer, adrenerger und antiandrogener Ebene erreicht werden. Der Enwicklung einer hormonrefraktären Situation, das heisst, eines PSA–Anstiegs und des Auftretens von Metastasen trotz Testosteronablation, kann nur in palliativen Therapieansätzen durch Chemotherapie begegnet werden. Eine Vielzahl von zielgerichteten Therapeutika und Chemotherapeutika sind in diesem Krankheitsstadium in der klinischen Prüfung. Besonderes Augenmerk bedarf der supportiven Situation der Begleitsymptome, unter denen die Schmerzkontrolle einen hohen Stellenwert einnimmt.

Despite technical progress in the treatment of carcinoma of the prostate gland, the disease progresses in the course of 10 years in 27  % to 54  % of the patients and requires palliative drug therapy. If the prostate–specific antigen (PSA) increaes subsequent to initial surgery, it will be necessary to concider the possibility of either a local recurrence or of a lymphogenic or a hematogenic metastasis for estimating the need for secondary radiation of the previous location of the tumor. The proliferative action of testosterone on the cell of the prostate gland carcinoma may be achieved via hormonal suppression on a hypophyseary, adrenergical or anti–androgenical level. Palliative attempts via chemotherapy are the only recourse to meet the development of a refractory antihormonal situation, i.e. a PSA increase and the occurrence of metastases despite testosterone ablation. To meet this stage of the disease, clinical tests are under way covering a multitude of on–target therapeutics and chemotherapeutics. Special attention must be paid to the supportive situation of the accompanying symptoms, pain management being one of its most prominent elements.

Key words

Carcinoma of the prostate gland - palliative therapy - PSA level - hormone–refractory - hormonal manipulation - testosterone - metastases

Literatur

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