Bedeutung und Nutzen von PSMA-Liganden beim Prostatakarzinom

Zusammenfassung

Über die letzten Jahre haben PSMA-Liganden in der PET-Diagnostik, wie der Tracer ⁶⁸Ga-PSMA-11, vielversprechende Ergebnisse gezeigt und so zur Verbesserung der Versorgung von Prostatakarzinompatienten beigetragen. Den häufigsten Einsatz in der bildgebenden Diagnostik hat z. Z. der Tracer ⁶⁸Ga-PSMA-11 im biochemischen Rezidiv des Prostatakarzinoms. Hier zeigt die ⁶⁸Ga-PSMA-11 PET/CT im Vergleich zu konventionellen Bildgebungsmodalitäten hervorragende Detektionsraten. Insbesondere kleine, morphologisch unauffällige Läsionen sowie Läsionen bei geringen PSA-Werten können besser detektiert werden. Auch im primären Staging von High risk-Patienten, vor allem in Kombination mit der multiparametrischen MRT, stellt die ⁶⁸Ga-PSMA PET eine aussichtsvolle Alternative dar. Neben der wachsenden Anwendung in der Diagnostik, werden verschiedene PSMA-Liganden auch bereits im therapeutischen Bereich erfolgreich eingesetzt. Therapierefraktäre metastasierte Prostatakarzinompatienten zeigten ein gutes Ansprechen auf die PSMA-Radioligandentherapie mit kontrollierbaren Nebenwirkungen.

Aufgrund der aktuellen Entwicklungen werden PSMA-Liganden beim Management von Prostatakarzinompatienten weiterhin eine wichtige Rolle einnehmen und ihr Einsatz eine verbreiterte Anwendung finden.

Abstract

In recent years, PSMA-targeting PET tracers such as ⁶⁸Ga-PSMA-11 have shown promising results, thus contributing to a better management of prostate cancer patients. At the present time, ⁶⁸Ga-PSMA-11 is most frequently used for diagnostic evaluation in the setting of biochemical recurrence of prostate cancer. In this context, the ⁶⁸Ga-PSMA-11 PET/CT delivers superior detection rates compared to conventional imaging, especially for the detection of small, unsuspicious lesions or lesions in the presence of low PSA values. Furthermore, ⁶⁸Ga-PSMA PET imaging seems to be an encouraging alternative for the staging of high-risk patients, particularly in combination with multiparametric MRI. In addition to the increasing use of PSMA ligands in clinical diagnostics, some variants have also been successfully applied in therapy. Advanced metastasized prostate cancer patients showed a good response to PSMA radioligand therapy with tolerable side-effects after failure of guideline-compliant treatment.

Due to recent developments, PSMA ligands will continue to play an important role in the management of prostate cancer patients and will be more widely used in the future.

Schlüsselwörter

Prostatakarzinom - PSMA - PET - Staging - Radioligandentherapie

Key words

prostate cancer - PSMA - PET - staging - radioligand therapy

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