Aktive Überwachung beim Niedrigrisikoprostatakarzinom

Abstract

In Europe prostate cancer is one of the most common cancers among men. The diagnostics always include a control of the prostate-specific antigen (PSA) level and examination of a representative tissue sample from the prostate. With these findings it is possible to evaluate the degree of progression of the cancer and its prognosis. Several treatment options for localized prostate cancer are given by national and international guidelines including radical prostatectomy, percutaneous radiation therapy, or brachytherapy and surveillance of the cancer with optional treatment at a later stage. For the latter treatment option, known as active surveillance, strict criteria have to be met. The advantage of active surveillance is that only patients with progressive cancer are subjected to radical therapy. Patients with very slow or non-progressing cancer do not have to undergo therapy and thus do not have to suffer from the side effects. The basic idea behind active surveillance is that some cancers will not progress to a stage that requires treatment within the lifetime of the patient and therefore do not require treatment at all. Unfortunately the criteria for active surveillance are not definitive enough at the current time leading only to a delay in effective treatment for many patients. The surveillance strategy has without doubt a high significance among the treatment options for prostate cancer; however, at the current time it lacks reliable indicators for a certain prognosis. Therefore, patients must be informed in detail about the advantages and disadvantages of active surveillance.

Final pathohistology after radical prostatectomy in patients eligible for active surveillance (AS)

“…The identification of histologically and clinically insignificant carcinoma and/or of patients suitable for AS is the deciding factor for success of this type of therapy. In spite of ever more stringent pretherapeutic parameters to improve the predictive accuracy, there are at this time still no criteria which will detect with sufficient certainty a clinically insignificant carcinoma or which could exclude a clinically significant prostate carcinoma [7]. It is estimated that onethird of patients with a low-risk prostate carcinoma will be reclassified over time into a higher-risk group, either due to a progression from a low-risk to a high-risk carcinoma or-as is the case in the majority of patients-due to the failure to recognize a high-risk prostate carcinoma within the scope of a core needle biopsy of the prostate.…”