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Erschienen in: Journal für Urologie und Urogynäkologie/Österreich 3/2018

16.05.2018 | Originalien

Rolle der zytoreduktiven radikalen Prostatektomie beim oligometastasierten Patienten

Aktuelle Studienlage

verfasst von: PD Dr. Dr. Philipp Mandel, Markus Graefen, Thomas Steuber

Erschienen in: Journal für Urologie und Urogynäkologie/Österreich | Ausgabe 3/2018

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Zusammenfassung

Hintergrund

Bis heute ist die Rolle der zytoreduktiven Chirurgie bei oligometastatischem Prostatakarzinom (PCa) unklar. Ziel der vorliegenden Arbeit ist es, einen Überblick über die aktuelle Literatur und Studien zu geben.

Ergebnisse

Die zytoreduktive radikale Prostatektomie (CRP) bei Patienten mit einem oligometastatischen Prostatakrebs ist durchführbar und sicher. Während die perioperativen Komplikationsraten vergleichbar zu Patienten mit einem Hochrisiko-PCa sind, stellen sich die postoperativen funktionellen Ergebnisse (Harninkontinenz und erektile Funktion) im Vergleich leicht schlechter dar – hauptsächlich aufgrund geringerer Raten an nervenerhaltenden Operationen und des vermehrten Einsatzes von Androgendeprivationstherapien (ADT). Bislang konnte ein onkologischer Nutzen der CRP nur in retrospektiven, multiinstitutionellen Datenbanken und Fall-Kontroll-Studien nachgewiesen werden, nicht jedoch in prospektiven Studien. Ein klares Argument zugunsten der CRP ist jedoch die Reduktion schwerer lokaler Komplikationen im Vergleich zu Patienten, die nur eine systemische Therapie erhalten (bis zu >50 % vs. <10 %).

Schlussfolgerung

Während der onkologische Einfluss einer CRP immer noch diskutiert wird, kann eine signifikante Reduktion lokaler Komplikationen als Argument für ihre Durchführung bei Patienten mit oligometastatischem PCa angesehen werden. Dennoch müssen Patienten hinsichtlich der relevanten Komplikationen und des schlechteren funktionellen Ergebnisses im Vergleich zum lokalisierten Hochrisiko-PCa aufgeklärt werden und sollten nur innerhalb klinischer Studien therapiert werden.
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Metadaten
Titel
Rolle der zytoreduktiven radikalen Prostatektomie beim oligometastasierten Patienten
Aktuelle Studienlage
verfasst von
PD Dr. Dr. Philipp Mandel
Markus Graefen
Thomas Steuber
Publikationsdatum
16.05.2018
Verlag
Springer Vienna
Erschienen in
Journal für Urologie und Urogynäkologie/Österreich / Ausgabe 3/2018
Print ISSN: 1023-6090
Elektronische ISSN: 1680-9424
DOI
https://doi.org/10.1007/s41972-018-0041-3

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