TumorDiagnostik & Therapie 2021; 42(06): 446-452
DOI: 10.1055/a-1532-7220
Thieme Onkologie aktuell

Der onkologische Nutzen der pelvinen Lymphadenektomie ist beim Prostatakarzinom nicht geklärt

It is unclear whether pelvic lymphadenectomy is of oncological benefit in prostate cancer
Lothar Weißbach
1   GfM gGmbH Gesundheitsforschung für Männer, Urologie, Berlin
,
Christiane Roloff
2   GfM gGmbH Gesundheitsforschung für Männer, Allgemeinmedizin, Berlin
› Institutsangaben

Zusammenfassung

Der Review von Fossati 2017 stellt den Wert der pLA im Rahmen der RP infrage, weil sich aus den vorliegenden Studien kein onkologischer Nutzen ergibt. Nach wie vor ist die Beweislage wegen fehlender Evidenz dürftig. Unsere Feststellung, dass von metastasierten LK bisher keine Streuung nachgewiesen wurde, basiert auf Registerdaten, auf klinischen Studien ohne Nachweis eines pLA-Vorteils und auf Überlegungen zum genetischen Zusammenhang von LK- und Fernmetastasen. Der Verzicht auf die pLA bzw. auf die Bestrahlung eines Beckenfeldes wird durch die verbesserte Bildgebung mit dem 68Ga-PSMA-PET/CT zum Nachweis von Metastasen erleichtert. Wenn LK nicht metastasieren, wird das Ergebnis der Bildgebung diagnostisch zur Therapieplanung ausreichen. Somit kann auf die pLA aus diagnostischen Gründen verzichtet werden. Komplikationen wären ausgeschlossen. Um die Frage zu klären, ob die pLA bzw. ein multimodales Behandlungskonzept Intermediate- und High-risk-Patienten nützen, wird ein RCT notwendig sein, in dem v. a. der nicht vollständig entfernte Primarius als Streuquelle berücksichtigt wird.

Abstract

Fossati's 2017 review questions the value of pelvic lymphadenectomy (pLA) in radical prostatectomy (RP) because available studies fail to show any oncological benefit. Our finding that no spread of metastatic lymph nodes (LN) has been demonstrated is based on registry data, clinical trials without evidence of pLA benefit and considerations of the genetic link between LN metastasis and distant metastases. The improved imaging with 68GaPSMA-PET-CT facilitates the detection of metastases and thus the omission of pLA as diagnostic intervention, thereby avoiding typical complications. The question whether pLA, or a multimodal treatment concept, might benefit intermediate and high-risk patients can only be answered by an RCT which, above all, must consider the incompletely removed primary as a source of metastatic spread.



Publikationsverlauf

Artikel online veröffentlicht:
29. Juli 2021

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