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01.08.2007 | Leitthema

Diagnostik und Therapie des PSA-Progresses nach lokaler Primärtherapie des Prostatakarzinoms

verfasst von: Prof. Dr. K. Miller, A. Lingnau

Erschienen in: Die Onkologie | Ausgabe 8/2007

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Zusammenfassung

Der Anstieg des prostataspezifischen Antigens nach radikaler Prostatektomie (RP) oder nach kurativer Strahlentherapie (RT) ist das frühe Zeichen einer Tumorprogression. Die aktuelle Definition nach RP ist 0,4 ng/ml und weiter steigend, die nach RT Nadir + 2 ng/ml. Die Prognose dieser Patienten ist heterogen. Die wesentlichen Prognoseparameter sind Gleason-Score, Zeit bis zum Auftreten der PSA-Progression und PSA-Verdopplungszeit (PSA-DT). Bildgebende Verfahren spielen in der frühen Phase (PSA<0,5 ng/ml) nach radikaler Prostatektomie, in der die Entscheidung für eine Salvage-RT getroffen werden muss, keine wesentliche Rolle. Nach kurativer Strahlentherapie ist für die Entscheidung zur lokalen Salvagetherapie (Prostatektomie, Kryotherapie, HIFU) eine Biopsie indiziert. Nach radikaler Prostatektomie erreichen im Langzeitverlauf ohne Therapie nur ca. 30% der Patienten das Stadium der klinischen Metastasierung, nach kurativer Strahlentherapie häufiger (bis 75%). Dies ist bei der Indikationsstellung zur Hormontherapie zu bedenken. Bei fehlenden aussagekräftigen prospektiven Studien sind der optimale Zeitpunkt und die Art der Hormontherapie derzeit nicht definiert.
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Metadaten
Titel
Diagnostik und Therapie des PSA-Progresses nach lokaler Primärtherapie des Prostatakarzinoms
verfasst von
Prof. Dr. K. Miller
A. Lingnau
Publikationsdatum
01.08.2007
Verlag
Springer-Verlag
Erschienen in
Die Onkologie / Ausgabe 8/2007
Print ISSN: 2731-7226
Elektronische ISSN: 2731-7234
DOI
https://doi.org/10.1007/s00761-007-1228-6

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