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Aktuelle Urol 2016; 47(05): 388-394
DOI: 10.1055/s-0042-113547
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Therapie des Primärtumors beim metastasierten Prostatakarzinom

Primary Tumour Treatment in Patients with Metastatic Prostate Cancer
T. Steuber
1   Martini-Klinik, Prostatakarzinomzentrum am Universitätsklinikum Hamburg-Eppendorf, Hamburg
,
B. Beyer
1   Martini-Klinik, Prostatakarzinomzentrum am Universitätsklinikum Hamburg-Eppendorf, Hamburg
› Author Affiliations
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Publication History

Publication Date:
28 September 2016 (online)

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Zusammenfassung

Aufgrund der ungünstigen Prognose wird nach aktuellen Behandlungsstandards beim primär metastasierten (M1) Prostatakarzinom (PCa) die Lokaltherapie (radikale Prostatektomie oder Radiatio der Prostata) nicht empfohlen. Jedoch entwickelt jeder M1 Patient unweigerlich einen kastrationsresistenten Progress, der bei mehr als der Hälfte der Betroffenen zu lokalen Komplikationen führt. Eine Lokaltherapie, sofern mit einer guten Lebensqualität (QoL) vereinbar, hätte somit den Nutzen, späteren lokalen Komplikationen vorzubeugen. Zudem deuten aktuelle Daten aus der Genomforschung darauf hin, dass Tumoren mit einem hohen Metastasierungspotenzial durch Karzinomzellreduktion mittels Entfernung des Primärtumors sowie der Lymphknoten der Ursprung weiterer letaler Tumorklone genommen wird. Daraus ergibt sich das derzeit noch als experimentell anzusehende Therapiekonzept der präventiven, zytoreduktiven Lokaltherapie. Registerstudien aus den USA sowie aus Deutschland weisen auf einen Überlebensvorteil primär metastasierter Patienten hin, wenn die Standardsystemtherapie mit einer Lokaltherapie kombiniert wird. Derzeit liefern diese Daten die Grundlage um Hypothesen zu generieren, die wiederum die Rationale für prospektiv randomisierte Studien darstellen, jedoch nicht ausreichen, um Therapieempfehlungen aussprechen zu können. Während sich derzeit ein dynamischer Paradigmenwechsel in der Systemtherapie des metastasierten, hormonnaiven Prostatakarzinoms vollzieht, wird die Lokaltherapie des Primarius nur über die erfolgreiche Rekrutierung und Komplettierung laufender klinischer Studien Einzug in den Therapiestandard primär metastasierter Patienten nehmen können.

Abstract

Prostate cancer (PCa) with distant metastasis at diagnosis (M1) is associated with an unfavourable prognosis. Therefore, according to current treatment guidelines, local treatment (radical prostatectomy or irradiation of the prostate gland) is not recommended in men with M1 disease. However, M1 patients inevitably develop castration-resistant disease progression leading to local complications in half of men. Hence, local treatment, if reconcilable with a good quality of life, would have the potential to prevent future local symptoms. Furthermore, evolving data from genomic studies suggest that local treatment might have the potential to reduce further spread of lethal cancer clones by eliminating the primary tumour or nodal metastasis. This leads to the experimental concept of cytoreductive preventative local treatment. According to large US-American and German cancer registries, there is a growing body of evidence pointing towards a survival benefit for M1 patients who receive local treatment in combination with systemic therapy. These data provide the basis to generate the hypothesis of a better response to systemic tumour therapy in metastatic prostate cancer, which would be the rationale for prospective randomised trials, but would not suffice for a treatment recommendation to be given. While there is a dynamic paradigm shift in the systemic treatment of hormone-naive M1 prostate cancer, local treatment for primary tumours will only have a chance to be established in this indication if prospective randomised trials are successfully completed.

Schlüsselwörter

metastasiertes Prostatakarzinom - radikale Prostatektomie - Radiatio der Prostata - Androgendeprivationstherapie

Key words

metastatic prostate cancer - radical prostatectomy - irradiation of the prostate gland - androgen deprivation therapy
 

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