Zusammenfassung
Das Prostatakarzinom ist in Deutschland die häufigste maligne Neoplasie beim Mann.
Das primär eingesetzte bildgebende Verfahren ist der transrektale Ultraschall
(TRUS). Zum histologischen Nachweis eines Prostatakarzinoms wird bei erhöhtem
PSA-Wert eine systematische TRUS-gesteuerte, transrektale Biopsie der Prostata
durchgeführt. Bei ein- oder mehrmaliger negativer Stanzbiopsie kann die Indikation
für eine MRT mit einer kombinierten Endorektal-Körper-Phased-Array-Spule bei 1,5
Tesla gestellt werden. Die dynamische, kontrastmittelunterstützte MRT und die
Protonenmagnetresonanzspektroskopie können in Kombination mit der konventionellen
MRT den Nachweis des Prostatakarzinoms verbessern. Für das lokale Staging des
Prostatakarzinoms ist die MRT besser geeignet als die digitale rektale Untersuchung
und der transrektale Ultraschall, wobei die in der Literatur genannten Treffsicherheiten
für diese Verfahren sehr unterschiedlich sind. Für den Nachweis von Knochenmetastasen
ist aktuell die Knochenszintigraphie mit 99mTc-Bisphosphonat die Methode der Wahl. Bessere Sensitivitäten konnten mit den
neueren Verfahren wie der Ganzkörper-MRT und der PET mit den Tracern 18F-FDG, 11C-Cholin und 11C-Acetat erreicht werden.
Abstract
Prostate cancer is the most common malignancy of men in Germany. Transrectal ultrasound
(TRUS) is the primary used imaging modality. Patients with elevated PSA levels
undergo systematic TRUS-guided transrectal biopsy of the prostate for histologic
confirmation of prostate cancer. Magnetic resonance imaging (MRI) using the combined
endorectal body phased-array coil may be indicated in men with one or more negative
prostate biopsies. The detection of prostate cancer by conventional MRI can be
improved by an additional dynamic contrast-enhanced MR study and proton MR spectroscopy.
Local staging of prostate cancer by MRI is more accurate compared with digital
rectal examination and transrectal ultrasound. However, accuracies reported in
the literature for these procedures vary widely. Bone scintigraphy with 99mTc-bisphosphonate is currently the method of choice for the detection of bone
metastases. However, more recent techniques such as whole-body MRI and PET using
18F-FDG, 11C-choline or 11C-acetate as tracers were found to have higher sensitivities.
Key words
Prostate cancer - TRUS - MRI - MRS - PET
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Dr. Tobias Franiel
Institut für Radiologie
Charité, Universitätsmedizin Berlin
Charitéplatz 1
D-10117 Berlin
Telefon: 030 450-527018
Fax: 030 450-527911
eMail: tobias.franiel@charite.de
