Aktuelle Urol 2020; 51(06): 547-551
DOI: 10.1055/a-0758-9944
Übersicht
Thieme. All rights reserved. (2020) Georg Thieme Verlag KG

Antihormonelle Therapie des Prostatakarzinoms − Behandlungsindikation und kardiovaskuläres Risikoprofil − Vorteil für GnRH-Antagonisten?

Antihormonal therapy of prostate cancer – treatment indication and cardiovascular risk profile – advantage for GnRH antagonists?
Thomas Höfner
Universitätsmedizin Mainz, Klinik und Poliklinik für Urologie und Kinderurologie, Mainz
› Author Affiliations
Further Information

Publication History

Publication Date:
28 November 2018 (online)

Zusammenfassung

Das Prostatakarzinom ist die häufigste urologische Tumorerkrankung des Mannes. Im lokalisierten Tumorstadium in Kombination mit der Strahlentherapie und insbesondere im fortgeschrittenen metastasierten Tumorstadium stellt die klassische antihormonelle Therapie ein wesentliches Therapieverfahren dar. Seit ca. 10 Jahren nimmt unser Wissen um das kardiovaskuläre Risiko dieser Therapie ständig zu. Die hier vorliegende Übersichtsarbeit stellt die wesentlichen Arbeiten zum kardiovaskulären Risiko der antihormonellen Therapie vor und beschreibt im Besonderen die aktuellen Daten zum kardiovaskulären Risiko beim Einsatz der GnRH-Antagonisten. Die multizentrische prospektive PRONOUNCE-Studie soll die Frage nach einem tatsächlichen Vorteil der GnRH-Antagonisten-Therapie im Vergleich zur klassischen LHRH-Analoga-Therapie im Hinblick auf kardiovaskuläre Ereignisse detaillierter beantworten. Der Artikel stellt weiterhin das Problem der heutigen antihormonellen Übertherapie trotz fehlender wissenschaftlicher Evidenz heraus und weist auf eine verbesserte Patientenselektion für den Einsatz der antihormonellen Therapie hin.

Abstract

Introduction Prostate cancer is the most common urological tumour disease in men. In the localized tumour stage in combination with radiotherapy and especially in advanced metastastic disease, classical androgen deprivation remains an essential therapy. During the last 10 years, our knowledge of the cardiovascular risk of this therapy has rapidly increased.

Material and Methods This non-systematic review highlights the current data on cardiovascular risk in the use of androgen deprivation therapy in prostate cancer.

Results Essential publications about the cardiovascular risk of antihormonal therapy are summarised in detail. In particular, the current data on the potential cardiovascular benefit when using GnRH antagonists in androgen deprivation are discussed. The article further highlights the problem of today's antihormonal overtreatment, despite the lack of scientific evidence and points out that patient selection should be improved in the future.

Conclusion The multicentre prospective PRONOUNCE study has been designed to answer the question in more detail, as to whether GnRH antagonist therapy provides benefit with respect to the cardiovascular risk as compared to classical LHRH analogue androgen deprivation therapy.

 
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