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Rofo 2023; 195(11): 1001-1008
DOI: 10.1055/a-2088-9543
Review

PSMA-Hybridbildgebung in der Diagnostik des Prostatakarzinoms – aktuelle Anwendungen und Perspektiven

Article in several languages: English | deutsch
Daniel Koehler 
1   Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
,
Christoph Berliner 
2   Department of Nuclear Medicine, University Hospital Essen, Germany
,
Farzad Shenas
1   Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
,
Amir Karimzadeh
1   Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
,
Ivayla Apostolova
1   Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
,
Susanne Klutmann
1   Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
,
Gerhard Adam
1   Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
,
Markus Sauer 
1   Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Zusammenfassung

Hintergrund Das Prostatakarzinom (PCa) ist das häufigste Malignom des Mannes und die zweithäufigste krebsbedingte Todesursache der männlichen Bevölkerung in Deutschland. Die Bildgebung des prostataspezifischen Membranantigens (PSMA) mittels Hybridverfahren wie der Positronen-Emissions-Tomografie (PET) in Kombination mit der CT oder MRT stellt eine vergleichsweise neue Methode dar, die in den letzten Jahren zunehmend an Bedeutung in der Diagnostik des PCa gewonnen hat.

Methode Aktuelle Anwendungen der PSMA-Hybridbildgebung wurden basierend auf den deutschen und europäischen Leitlinien zum Thema Prostatakarzinom erörtert und um neue Entwicklungen basierend auf einer Literaturrecherche in PubMed aus 10/22 ergänzt.

Ergebnisse Die PSMA-PET/CT weist sowohl im Primärstaging von Hochrisikoprostatakarzinomen als auch beim Rezidiv nach Primärtherapie höhere Detektionsraten von Metastasen als die etablierten Methoden (CT, MRT und Skelettszintigrafie) auf. Trotz vielversprechender Ergebnisse prospektiver Studien in beiden Szenarien und dem deutlichen Einfluss der PSMA-PET auf Therapieentscheidungen liegen aktuell noch keine Analysen bezüglich ihres Einflusses auf das PCa-spezifische Überleben und das Gesamtüberleben vor. Daher wird in den meisten Situationen eine „kann“-Empfehlung für die PSMA-PET/CT ausgesprochen. Neue Behandlungsstrategien wie die metastasengerichtete Therapie oder die PSMA-Radioligandentherapie erweitern jedoch bereits jetzt schon den Einsatzbereich der PSMA-PET und verankern sie weiter im klinischen Alltag.

Schlussfolgerung Die PSMA-Hybridbildgebung stellt in verschiedenen Stadien des PCa die sensitivste Staging-Methode dar und ermöglicht damit die Entwicklung neuer Behandlungskonzepte. Prospektive Analysen sind jedoch notwendig, um ihren Einfluss auf das Patientenüberleben zu evaluieren.

Kernaussagen 

  • Die PSMA-PET/CT ist der konventionellen Bildgebung beim Staging von Hochrisikoprostatakarzinomen überlegen.

  • Im biochemischen Rezidiv kann die PSMA-Hybridbildgebung bereits bei niedrigen PSA-Werten Filiae erkennen.

  • Therapieentscheidungen werden häufig durch Erkenntnisse aus der PSMA-PET/CT beeinflusst.

Zitierweise

  • Koehler D, Berliner C, Shenas F et al. PSMA hybrid imaging in prostate cancer – current applications and perspectives. Fortschr Röntgenstr 2023; 195: 1001 – 1008

Key words

prostate - PET-CT - metastases - PET - staging


Publication History

Received: 24 November 2022

Accepted: 28 April 2023

Article published online:
22 June 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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