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Deutsche Zeitschrift für Onkologie 2013; 45(04): 144-151
DOI: 10.1055/s-0033-1357566
Forschung
© Karl F. Haug Verlag in MVS Medizinverlage Stuttgart GmbH & Co. KG

Prognostische DNA-Zytometrie beim Prostatakarzinom

Alfred Böcking
,
Josef Dietz
Further Information

Publication History

Publication Date:
17 December 2013 (online)

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Zusammenfassung

Der subjektive Gleason-Score (GS) schätzt die Prognose von Patienten mit Prostatakarzinom nicht sicher genug ein, um davon schwerwiegende Entscheidungen über Therapiemaßnahmen abhängig zu machen. In Karzinomen nehmen, bedingt durch chromosomale Instabilität im Rahmen der zytogenetischen Tumorprogression, Ausmaß und Variabilität chromosomaler Aberrationen (Aneuploidie) zu. Damit geht eine zunehmende Malignität der Tumoren einher. Durch Messung des DNA-Gehalts in Hunderten von Tumorzellen aus Stanzbiopsien kann man das Ausmaß der DNA-Aneuploidie als objektives Maß für die Bösartigkeit individueller Karzinome bestimmen. Niedrigrisiko-Karzinome der Prostata zeigen mit den gängigen Messmethoden von gesunden Zellen nicht unterscheidbare, peridiploide DNA-Gehalte. Aufgrund der aktuellen S3-Leitlinien Prostatakarzinom für eine Aktive Überwachung infrage kommende Patienten mit solchen, prognostisch sehr günstigen DNA-Verteilungen können sich dieser Strategie beruhigter anvertrauen als aufgrund eines niedrigen Gleason-Scores < = 6 alleine. Für Patienten mit Prostatakarzinomen höherer DNA-Malignitätsgrade sollten jedoch unmittelbar kurative Ansätze gewählt werden, da ihr Risiko für einen Progress nachweislich erhöht ist.

Summary

Subjective Gleason-Score does not assess the prognosis of prostate cancer patients with sufficient accuracy to make serious decisions on therapeutic strategies dependent from it. In cancer cells the degree and variability of chromosomal aberrations (aneuploidy) often increases due to chromosomal instability. This is accompanied by increasing malignancy. The degree of DNA-aneuploidy as an objective measure of the malignant potential of individual cancers can be assessed by measuring the DNA-content in hundreds to thousands of cancer cells from existing biopsies. Low-risk cancers of the prostate reveal nuclear DNA-contents that cannot be differentiated from those of normal diploid cells. Patients who according to current S3-guilines are suitable for the Active Surveillance strategy and who reveal such prognostical favourable diploid DNA-distributions, can more confidently rely on this strategy than based on a Gleason-Score < = 6 alone. Patients with prostate cancer of higher DNA-grades of malignancy instead should be reccommended for an immediate curative therapy, as their risk of tumor-progression otherwise is too high.

Schlüsselwörter

Prostatakarzinom - Prognose - Gleason-Score - DNA-Zytometrie - DNA-Grading - Aktive Überwachung

Keywords

Prostate cancer - prognosis - Gleason-score - DNA-cytometry - Active Surveillance - DNA-Grading
 

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