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27.02.2019 | Prostatakarzinom | Leitthema

Active Surveillance und die moderne Diagnostik des Prostatatkarzinoms

Multiparametrische MRT, Fusionsbiopsien und neue genetische Biomarker

verfasst von: Dr. Sami-Ramzi Leyh-Bannurah, PD Dr. Hannes Cash, Dr. Angelika Borkowetz, Prof. Dr. Markus Graefen, Prof. Dr. Thorsten Schlomm, Prof. Dr. Boris Hadaschik, PD Dr. Lars Budäus

Erschienen in: Die Onkologie | Ausgabe 4/2019

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Zusammenfassung

Hintergrund

Ein Teil der Prostatakarzinome wird in der primären Prostatabiopsie nicht detektiert, sodass bei weiterbestehendem Verdacht eine erneute Biopsie erfolgen muss. Neben der Problematik der Falsch-negativ-Rate in der systematischen Biopsie, besteht eine hohe Missklassifikationsrate, insbesondere das Tumorgrading betreffend. Dadurch kann es zu einer verspäteten Diagnose aggressiverer Tumoreigenschaften und im ungünstigsten Falle zu einem Versäumnis kurativer Ansätze kommen. Aufgrund dieser Problematik bestehen zahlreiche Ansätze, die Therapieentscheidung und Überwachung durch den Einsatz moderner Bildgebung und genetischer Biomarker zu optimieren

Ziel

Der Beitrag vermittelt eine Übersicht über die Active-Surveillance(AS)-Definitionen, die Problematik der Prostatakarzinomdetektion und genaue Grading-Abschätzung in der systematischen transrektalen Biopsie und den Einsatz der multiparametrischen MRT (mpMRT), der gezielten MRT- Fusionsbiopsie und genetischer Biomarker als potenzielle Lösungsansätze sowie deren Integration im klinischen Alltag.

Material und Methoden

Aktuelle Literatur wurde recherchiert und im Kontext mit eigenen Erfahrungen ausgewertet.

Ergebnisse

Die mpMRT sowie die gezielte MRT-Fusionsbiopsie sind dem aktuellen Standard der systematischen Biopsie in der Detektion des klinisch signifikanten Prostatakarzinoms überlegen. Besonders deutlich zeigt sich dies im Falle der Wiederholungsbiopsie des anterioren Prostatakarzinoms, einer persistierend suspekten PSA-Dynamik und Einschluss und Monitoring von AS-Patienten. Auch die Kombination mit weiteren neuartigen Prädiktoren sind weitere vielversprechende Ansätze.

Schlussfolgerung

Der potenzielle diagnostische Mehrwert kann ausschließlich durch eine interdisziplinäre Verknüpfung der zunehmend komplexeren diagnostischen Schritte erreicht werden. Effektive Lösungen im Rahmen der interdisziplinären Zusammenarbeit von Radiologen und Urologen auf Niveau der Fachgesellschaften sind notwendig, um Fragen bezüglich des Zeitaufwands und der Ressourcenverteilung mit den Leistungserstattern zu adressieren.
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Metadaten
Titel
Active Surveillance und die moderne Diagnostik des Prostatatkarzinoms
Multiparametrische MRT, Fusionsbiopsien und neue genetische Biomarker
verfasst von
Dr. Sami-Ramzi Leyh-Bannurah
PD Dr. Hannes Cash
Dr. Angelika Borkowetz
Prof. Dr. Markus Graefen
Prof. Dr. Thorsten Schlomm
Prof. Dr. Boris Hadaschik
PD Dr. Lars Budäus
Publikationsdatum
27.02.2019
Verlag
Springer Medizin
Erschienen in
Die Onkologie / Ausgabe 4/2019
Print ISSN: 2731-7226
Elektronische ISSN: 2731-7234
DOI
https://doi.org/10.1007/s00761-019-0533-1

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