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Deutsche Zeitschrift für Onkologie 2013; 45(04): 179-184
DOI: 10.1055/s-0033-1357567
Praxis
© Karl F. Haug Verlag in MVS Medizinverlage Stuttgart GmbH & Co. KG

Individualisierte Active Surveillance-Strategie bei Prostatakrebs

Ernst Herbert Bliemeister
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Publication History

Publication Date:
17 December 2013 (online)

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Zusammenfassung

Die Zahl der Neuerkrankungen an Prostatakrebs (PK) steigt beständig. Trotz frühzeitiger Therapie versterben daran noch genauso viele Männer wie 1971. Lebensgefährlich ist bei Diagnose nur die Minderzahl aller PK. Da die etablierte Gleason-Methode die Gefährlichkeit von PK zu unscharf bestimmt und keine Prognose erkennt, häufen sich Überdiagnostik und Übertherapie von PK. Die DNA-Bildzytometrie misst das individuelle Bedrohungspotenzial von PK exakt und zeigt seine Prognose. So kann die Masse der Neuerkrankten mit kaum bedrohlichem PK zunächst gefahrlos auf Therapie verzichten. Dabei muss das Verhalten ihres PK exakt überwacht werden. Die individualisierte Active Surveillance-Strategie wird vorgestellt.

Summary

The number of newly diagnosed prostate cancer is increasing rapidly, while the annual number of men dying from prostate cancer has remained stationary since 1971 despite early therapy. Only few prostate cancers are critical at time of diagnosis. Over diagnosis and over treatment of prostate cancer is rather common, as the Gleason-score is neither able to define its aggressiveness precisely nor predicts its prognosis. DNS-Image-Cytometry gauges individual risk minutely determining its prognosis. Thus, the majority of men with no critical cancer can refrain from immediate therapy, but do require tight control. Individual active surveillance strategy is explained.

Schlüsselwörter

individualisierte AS-Strategie - insignifikanter PK - Angst deeskalieren - DNA-Malignitätsgrad - DNA-Bildzytometrie - chromosomale Aneuploidie - optimale Krebskontrolle - maximale Lebensqualität

Keywords

individual acitive surveillance strategy - insignificant prostate cancer - idle fear of prostate cancer - DNS-Grading - DNS-Image-Cytometry - chromosomal aberration - best prostate cancer treatment - maximum quality of life
 

  • Literatur

  • 1 Allsbrook WC et al Interobserver reproducibility of Gelason grading of prostatic carcinoma : urologic pathologists. Human Pathol 2001; 32(1): 74-80
    CrossrefPubMedGoogle Scholar
  • 2 Augustin H, Hammerer PG, Graefen M et al Insignificant prostate cancer in radical prostatectomy specimen: time trends and preoperative prediction. Eur Urol 2003; 43(5): 455-460
    CrossrefPubMedGoogle Scholar
  • 3 Bahnsen U. Test oder Tombola. Um die Früherkennung von Prostatakrebs steht es schlecht. Die Zeit 2008; 34 25
    PubMedGoogle Scholar
  • 4 Bliemeister EH. Die Angst vor dem Prostatakrebs − PSA-Screening und die Folgen. Die Naturheilkunde 03/2010, Forum Komplementäre Onkologie S.3 ff
    PubMedGoogle Scholar
  • 5 Böcking A. Wie gelangt die saure Prostataphosphatase ins Blut? Eine ultrahistochemische Untersuchung. Pathologe 1982; 3: 175-176
    PubMedGoogle Scholar
  • 6 Böcking A et al DNA Grading of Malignancy and Tumor Regression in Prostatic Carcinoma under Hormone Therapy. Appl Path 1985; 3: 206-214
    PubMedGoogle Scholar
  • 7 Böcking A, Börgermann C, Dietz J. Prostatakrebs − Überwachung oder Therapie nach Bestimmung der Bösartigkeit mit DNA-Zytometrie. Hrsg. vom Landesverband Prostatakrebs Selbsthilfe Baden-Württemberg e. V Stuttgart 2013;
    PubMedGoogle Scholar
  • 8 Burchardt M, Engers R, Müller M et al Interobserver reproducibility of Gleason-grading: Evaluation using prostate cancer tissue microarrays. J Clin Cancer Res Clin Oncol 2008; 134: 1071-1078
    PubMedGoogle Scholar
  • 9 Carter HB, Epstein JI, Chan DW et al Recommended prostatespecific antigen testing intervals for the detection of curable prostate cancer. JAMA 1997; 277(18): 1456-1460
    CrossrefPubMedGoogle Scholar
  • 10 Chan TY, Chan DY, Stutzman KL, Epstein JI. Does increased needle biopsy sampling of the prostate detect a higher number of potentially insignificant tumors?. J Urol 2001; 166(6): 2181-2184
    CrossrefPubMedGoogle Scholar
  • 11 Cooperberg MR, Broering JM, Kantoff PW, Carroll PR. Contemporary trends in low risk prostate cancer: risk assessment and treatment. J Urol 2007; 178(3 Pt 2): S14−S19
    PubMedGoogle Scholar
  • 12 Dong F, Kattan MW, Steyerberg EW et al Validation of pretreatment nomograms for predicting indolent prostate cancer: efficacy in contemporary urological practice. J Urol 2008; 180(1): 150-154
    CrossrefPubMedGoogle Scholar
  • 13 Draisma G, Postma R, Schröder FH et al Gleason score, age and screening: modelling dedifferentiationin prostate cancer. Int J Cancer 2006; 119: 2366-2371
    CrossrefPubMedGoogle Scholar
  • 14 Duesberg P, Iacobuzio-Donahue C, Brosnan JA et al Origin of metastases. Subspecies of cancers generated by intrinsic karytotypic variations. Cell Cycle 2012; 11(6): 1151-1166
    CrossrefPubMedGoogle Scholar
  • 15 Duesberg P, McCormack A. Immortality of cancers. A consequence of inherent karyotypic variations and selection for autonomy. Cell Cycle 2013; 12(5): 783-802
    CrossrefPubMedGoogle Scholar
  • 16 Elgamal AA, van Poppel HP, van de Voorde WM et al Impalpable invisible stage T1c prostate cancer: characteristics and clinical relevance in 100 radical prostatectomy specimens–a different view. J Urol 1997; 157(1): 244-250
    CrossrefPubMedGoogle Scholar
  • 17 Engelhard M. Kinetiken des Prostata Spezifischen Antigens als Indikationsstellung zur Prostatastanzbiopsie. [Med. Diss.] Düsseldorf: Universität Düsseldorf; 2013
    Google Scholar
  • 18 Epstein JI, Walsh PC, Carmichael M, Brendler CB. Pathologic and clinical findings to predict tumor extent of nonpalpable (stage T1c) prostate cancer. JAMA 1994; 271(5): 368-374
    CrossrefPubMedGoogle Scholar
  • 19 Epstein JI, Walsh PC, Akingba G, Carter HB. The significance of prior benign needle biopsies in men subsequently diagnosed with prostate cancer. J Urol 1999; 162(5): 1649-1652
    CrossrefPubMedGoogle Scholar
  • 20 Epstein JI, Amin M, Boccon-Gibot L et al Prognostic factors and reporting of prostate carcinoma in radical prostatectomy and pelvic lymphadenectomy specimens. Scand J Urol Nephrol Suppl 2005; 216: 34-63
    PubMedGoogle Scholar
  • 21 Goto Y, Ohori M, Arakawa A et al Distinguishing clinically important from unimportant prostate cancers before treatment: value of systematic biopsies. J Urol 1996; 156(3): 1059-1063
    CrossrefPubMedGoogle Scholar
  • 22 Han M, Partin AW, Pound CR et al Long-term biochemical disease-free and cancer-specific survival following anatomic radical retropubic prostatectomy. The 15-year Johns Hopkins experience. Urol Clin North Am 2001; 28(3): 555-565
    CrossrefPubMedGoogle Scholar
  • 23 Harnden P, Naylor B, Shelley MD et al The clinical management of patients with a small volume of prostatic cancer on biopsy: what are the risks of progression? A systematic review and meta-analysis. Cancer 2008; 112(5): 971-981
    CrossrefPubMedGoogle Scholar
  • 24 HAROW − Versorgungsstudie zur Behandlung des lokal begrenzten Prostatakarzinoms von Prof. Dr. med. Lothar Weißbach. Fürth/Berlin, Oktober 2007
    PubMedGoogle Scholar
  • 25 Irwin MB, Trapasso JG. Identification of insignificant prostate cancers: analysis of preoperative parameters. Urology 1994; 44(6): 862-867
    CrossrefPubMedGoogle Scholar
  • 26 Kattan MW, Eastham JA, Wheeler TM et al Counseling men with prostate cancer: a nomogram for predicting the presence of small, moderately differentiated, confined tumors. J Urol 2003; 170(5): 1792-1797
    CrossrefPubMedGoogle Scholar
  • 27 Klotz L. Active surveillance versus radical treatment for favorable-risk localized prostate cancer. Curr Treat Options Oncol 2006; 7(5): 355-362
    CrossrefPubMedGoogle Scholar
  • 28 Koppie TM, Grossfeld GD, Miller D et al Patterns of treatment of patients with prostate cancer initially managed with surveillance: results from The CaPSURE database. Cancer of the Prostate Strategic Urological Research Endeavor. J Urol 2000; 164(1): 81-88
    CrossrefPubMedGoogle Scholar
  • 29 Loeb S, Roehl KA, Thaxton CS, Catalona WJ. Combined prostatespecific antigen density and biopsy features to predict „clinically insignificant“ prostate cancer. Urology 2008; 72(1): 143-147
    CrossrefPubMedGoogle Scholar
  • 30 Lu-Yao GL, Yao SL. Population-based study of long-term survival in patients with clinically localised prostate cancer. Lancet 1997; 349(9056): 906-910
    CrossrefPubMedGoogle Scholar
  • 31 Panagiotou I, Beer TM, Hsieh YC et al Predictors of delayed therapy after expectant management for localized prostate cancer in the era of prostatespecific antigen. Oncology 2004; 67(3−4): 194-202
    CrossrefPubMedGoogle Scholar
  • 32 Robert Koch-Institut. Gesundheitsberichterstattung des Bundes Heft 36; Prostataerkrankungen. Berlin: RKI; 2012
    Google Scholar
  • 33 Roehl KA, Antenor JA, Catalona WJ. Serial biopsy results in prostate cancer screening study. J Urol 2002; 167(6): 2435-2439
    CrossrefPubMedGoogle Scholar
  • 34 Steyerberg EW, Roobol MJ, Kattan MW et al Prediction of indolent prostate cancer: validation and updating of a prognostic nomogram. J Urol 2007; 177(1): 107-112
    CrossrefPubMedGoogle Scholar
  • 35 Taupitz J. Informationstechnologien: Haftungsschutz oder Haftungsfalle?. Dtsch Ärztebl vom 15.10.2010; 107(41). 1972 ff.
    PubMedGoogle Scholar
  • 36 Tils M. Häufigkeit von DNA-Ploidiemustern in Stanzbiopsien vom Prostatakarzinom. [Med. Diss.] Düsseldorf: Universität Düsseldorf; 2013
    Google Scholar
  • 37 Tribukait B. Tumor biology in diagnostic cytology: DNA cytometry in carcinomas of the bladder and prostate. Recent Results Cancer Res 1993; 133: 23-31
    PubMedGoogle Scholar
  • 38 Tribukait B. Nuclear deoxyribonucleic acid determination in patients with prostate carcinomas: Clinical research and application. Eur Urol 1993; 23(Suppl 2): 64-76
    PubMedGoogle Scholar