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01.09.2015 | Leitthema

Kontroversen der Therapie des Hochrisiko-Prostatakarzinoms

Strahlentherapie

Erschienen in: Die Onkologie | Ausgabe 9/2015

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Zusammenfassung

Hintergrund

Derzeit ist für die Behandlung des Prostatakarzinoms (PCa) mit hohen Risikofaktoren keine Standardtherapie definiert. In der kurativ intendierten Behandlung stehen die definitive Strahlentherapie mit antihormoneller Therapie und die radikale Prostatovesikulektomie mit pelviner Lymphadenektomie zur Verfügung.

Ziel

Die Autoren vermitteln und bewerten die Rolle der Strahlentherapie (+ / -medikamentöse Therapie) anhand der vorhandenen Evidenz.

Methoden und Material

Anhand der unten angegebenen Suchbegriffe wird die Literatur der letzten 5 Jahre durchsucht.

Ergebnisse

Zur Therapie von Patienten mit Hochrisiko-PCa existieren randomisierte Studien zum Vergleich einer kombinierten Radiotherapie plus Hormonentzugstherapie vs. Radiatio oder Hormontherapie alleine, die einen signifikanten Vorteil zugunsten der kombinierten Therapie in allen Endpunkten zeigten. Ein Vergleich Radiotherapie vs. Operation existiert nicht. Die Evidenz beschränkt sich hierbei auf retrospektive, meist monoinstitutionelle Untersuchungen (Evidenzlevel: 3–4), allerdings mit z. T. großen Patientenkohorten. Die moderne dosiseskalierte Strahlentherapie in Kombination mit einer Hormonentzugstherapie erzielt sehr gute Ergebnisse hinsichtlich des rezidivfreien Überlebens sowie hinsichtlich therapiebedingter Nebenwirkungen, die einer alleinigen radikalen Prostatektomie insbesondere bei älteren Patienten (> 70 Jahre) überlegen sind. Bei jungen Patienten (< 60 Jahre) und in Kombination mit einer adjuvanten oder Salvage-Radiatio besteht keine klare Datenlage.

Schlussfolgerung

Derzeit kann für den einzelnen Hochrisiko-PCa-Patienten nur durch ein interdisziplinäres Aufklärungsgespräch mit Urologen und Radioonkologen eine individuell optimale Therapiesequenz gefunden werden.
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Metadaten
Titel
Kontroversen der Therapie des Hochrisiko-Prostatakarzinoms
Strahlentherapie
Publikationsdatum
01.09.2015
Erschienen in
Die Onkologie / Ausgabe 9/2015
Print ISSN: 2731-7226
Elektronische ISSN: 2731-7234
DOI
https://doi.org/10.1007/s00761-014-2900-2

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