Zusammenfassung
Einleitung
Bevorzugte Behandlungsoptionen für das lokalisierte Prostatakarzinom von deutschen Urologen und Radioonkologen wurden unter Berücksichtigung der unterschiedlichen Risikogruppen analysiert.
Material und Methoden
3217 Urologen und 598 Radioonkologen wurden mittels Fragebogen kontaktiert und unter der Annahme, sie seien persönlich an einem lokalisierten Prostatakarzinom erkrankt, bezüglich ihrer bevorzugten Primärtherapie befragt. Dabei wurde nach niedrigem (Gleason-Score≤6; PSA≤10 μg/l; T1c), mittlerem (Gleason-Score=7; PSA=11–19 μg/l; T2b) und hohem Rezidivrisiko (Gleason-Score≥8; PSA≥20 μg/l; T2c–T3) differenziert. Weiterhin wurde nach dem bevorzugten chirurgischen Zugangsweg (retropubisch, laparoskopisch, perineal) gefragt.
Ergebnisse
Die Rücklaufquote lag bei 49% für Urologen und 41% für Radioonkologen. Das mittlere Alter betrug 48 (28–86) Jahre für Urologen und 47 (29–68) Jahre für Radioonkologen. Die Operation als Therapie der Wahl bei niedrigem, mittlerem und hohem Risiko lag für Urologen bei 62%, 90% und 77%. Die Radiatio als Therapie der Wahl bei niedrigem, mittlerem und hohem Risiko lag für Radioonkologen bei 71%, 84% und 89%. Retropubische, laparoskopische und perineale Prostatektomie wären entsprechend von 61%, 28% und 10% der Urologen für Niedrigrisikoprostatakarzinom, von 70%, 24% und 6% für Mittelrisikoprostatakarzinom, und von 80%, 15% und 5% für Hochrisikoprostatakarzinom gewählt worden.
Zusammenfassung
Urologen bevorzugen für sich selbst chirurgische Therapieoptionen, während Radioonkologen eine Bestrahlung favorisieren. Gerade beim Prostatakarzinom mit hohem Rezidivrisiko bevorzugen Radioonkologen die Strahlentherapie als primäre Behandlungsform. In der Ära der minimal-invasiven Chirurgie ist die retropubische Prostatektomie weiterhin die bevorzugte chirurgische Therapieoption unter Urologen.
Abstract
Introduction
We evaluated the currently preferred primary treatment options among German urologists and radio-oncologists if personally diagnosed with localized prostate cancer, taking into consideration the different prognostic risk groups.
Materials and methods
A questionnaire was mailed to 3,217 urologists and 598 radio-oncologists. They were asked to choose their preferred primary treatment option if they were personally diagnosed with prostate cancer, taking into consideration the different prognostic risk groups: low risk [Gleason score ≤6, prostate-specific antigen (PSA) ≤10 μg/l, T1c], intermediate risk (Gleason score 7, PSA 11–19 μg/l, T2), and high risk (Gleason score ≥8, PSA≥20 μg/l, T3). Surgical options were further subdivided according to technique (retropubic, laparoscopic, perineal).
Results
The questionnaire return rate was 49% for urologists and 41% for radio-oncologists. The mean age was 48 years (28–86) for urologists and 47 years (29–68) for radio-oncologists. Primary surgical treatment was selected by 62% of urologists for low-risk prostate cancer, 90% for intermediate-risk prostate cancer, and 77% for high-risk prostate cancer. Radiotherapy as a primary treatment option was elected by 71% of radio-oncologists for low-risk prostate cancer, 84% for intermediate-risk prostate cancer, and 89% for high-risk prostate cancer. Retropubic, laparoscopic, and perineal prostatectomy would be chosen by 61%, 28%, and 10% of urologists, respectively, for low-risk prostate cancer; by 70%, 24%, and 6%, respectively, for intermediate-risk prostate cancer, and by 80%, 15%, and 5%, respectively for high-risk prostate cancer.
Conclusion
Urologists prefer surgery and radio-oncologists radiotherapy for primary treatment of prostate cancer, irrespective of the prognostic risk group. Particularly for high-risk prostate cancer, the majority of radiooncologists would still choose radiotherapy as a primary treatment option. In the age of minimally invasive surgery, radical retropubic prostatectomy is still the preferred surgical treatment option among urologists for any prognostic risk group.
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Danksagung
Wir danken Fr. Isabella Zwiener vom Institut für Medizinische Biometrie, Epidemiologie und Informatik der Universität Mainz für die statistische Auswertung.
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Gillitzer, R., Hampel, C., Thomas, C. et al. Bevorzugte Behandlungsoptionen des lokalisierten Prostatakarzinoms von deutschen Urologen und Radioonkologen bei eigener Erkrankung. Urologe 48, 399–407 (2009). https://doi.org/10.1007/s00120-008-1928-6
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DOI: https://doi.org/10.1007/s00120-008-1928-6