Geriatrische Urologie - Tumorerkrankungen

Zusammenfassung

Durch die Entwicklung der Bevölkerungsstruktur werden die urologischen Tumore als typische Tumore des höheren Lebensalters an Bedeutung zunehmen. Die hauptsächlich betroffene Patientengruppe weist häufig relevante Komorbiditäten und funktionelle Beeinträchtigungen auf, die in der Therapieplanung berücksichtigt werden müssen. In den letzten Jahrzehnten konnten im Bereich der operativen Versorgung urologischer Tumore erhebliche Fortschritte in den perioperativen Komplikationsraten erzielt werden. Dabei kommt vor allem einem interdisziplinärem perioperativem Management eine große Bedeutung zu, da die Prognose-relevanten Komplikationen vor allem nicht-urologische Probleme wie Infektionen, Verwirrtheitszustände, etc. betreffen. Gleichzeitig konnten in der systemischen Therapie des Prostatakarzinoms mit der Einführung der Taxane erstmalig Überlebensvorteile für eine palliative Chemotherapie erzielt werden. Mit Einführung des Gemcitabins in die Therapie der Blasentumore scheinen den bisherigen MVAC-Protokoll äquipotente, aber besser verträgliche Therapieprotokolle möglich. Die Rolle der Wachstumsfaktoren muss in der Therapie der urologischen Tumore noch definiert werden, sei es in der Intensivierung bisheriger Therapieschemata oder in der Verbesserung der Verträglichkeit der Protokolle. Eine interdisziplinäre Zusammenarbeit zwischen Urologen, Internisten und Geriatern ist zur adäquaten Individualisierung des Therapievorgehens sinnvoll und sollte proaktiv erfolgen.

Abstract

Due to demographic developments malignancies of urogenital origin will gain increasing importance. The urologist will face a growing group of patients with co-morbidities and functional disabilities as these neoplasms increase with age. Optimisation of peri-interventional management successfully reduces the risks of surgery. Integration of taxane-based cytostatic regimes achieves a prolongation of survival in hormone-refractory metastatic prostatic cancer. The introduction of gemcitabine in the management of malignancies of the bladder seems to have reduced toxicity while maintaining anti-tumour activity in comparison to MVAC. The role of haematopoetic growth factors remains to be defined in urologic malignancies - increasing dose intensity for better activity or reduction of toxicity. Individualisation of treatment requires early cooperation of the urologist, the oncologist and the geriatrician for an optimal outcome.

Schlüsselwörter

geriatrische Onkologie - Komorbidität - peripoperatives Management - systemische Chemotherapie

Key words

Geriatric oncology - co-morbidities - perioperative management - systemic chemotherapy

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