Bildgebende Diagnostik des primären Prostatakarzinoms: Aktueller Stand und neue Entwicklungen

Zusammenfassung

Dieser Artikel beschreibt die aktuellen bildgebenden Verfahren in Radiologie und Nuklearmedizin in der Primärdiagnostik des Prostatakarzinoms. Von radiologischer Seite spielt hier das multiparametrische MRT eine zunehmende Rolle, insbesondere bei klinisch vermutetem Prostatakarzinom und bereits vorherigen negativen Biopsien. Während die Skelettszintigrafie als herkömmliches nuklearmedizinisches Verfahren eine wichtige Rolle zum Ausschluss von Knochenmetastasen in bestimmten Stadien spielt, haben morphologische Verfahren im Nachweis von Lymphknotenmetastasen aufgrund ihrer eingeschränkten Sensitivität nur eine limitierte klinische Bedeutung. Trotz anfänglicher positiver Berichte hat klinisch die PET (insbesondere mit Cholin-Derivaten) in der Routinediagnostik des primären Prostatakarzinoms in den letzten Jahren keine wesentliche Rolle gespielt. Die kürzliche Einführung von PSMA-Liganden lässt hier mit ersten vorläufigen Ergebnissen deutliche Verbesserungen insbesondere im nodalen Staging erhoffen. Weitere Fortschritte sind in der Kombination von PSMA-Liganden und multiparametrischen MRT mittels der Hybridmodalität PET/MRT zu erwarten. Diese hat das Potenzial durch komplementäre molekulare Informationen aus der PET sowie dem funktionellen MRT in der Zukunft konventionelle Techniken insbesondere für den initialen Nachweis bzw. der Biopsieplanung eines Prostatakarzinoms abzulösen.

Abstract

This article summarizes the current radiological and nuclear medicine procedures in imaging primary prostate cancer. Multiparametric MRI of the prostate is increasingly used especially in patient with high suspicion of prostate cancer and prior negative biopsy. Skeletal scintigraphy is the traditional method for ruling out bone metastases in intermediate and advanced tumor stages whereas morphological imaging yield limited clinical benefit in lymph node staging due to its limited sensitivity. Despite initial encouraging reports (especially with Choline-derivates) clinically PET has played no substantial role in staging primary prostate cancer during the last years. Preliminary results reporting on the use of recently introduced PSMA (prostate specific membrane antigen) – ligands for PET show great promise for a substantial improvement especially in nodal staging. Further advances can be expected when combining PSMA-ligands and multiparametric MRI by hybrid PET/MRI. Due to its complementary molecular information from PET and functional MRI this technique yields the potential in replacing conventional procedures especially for primary diagnosis and biopsy planning in prostate cancer in the future.

Schlüsselwörter

Prostatakarzinom - Primärstaging - Cholin - PSMA - PIRADS - multiparametrisches MRT

Key words

prostate cancer - primary staging - Cholin - PSMA - PIRADS - multiparametric MRI

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