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Urologie Scan 2015; 02(01): 43-55
DOI: 10.1055/s-0034-1391396
Fortbildung
Uroonkologie der Prostata
© Georg Thieme Verlag KG Stuttgart · New York

Therapie des kastrationsresistenten Prostatakarzinoms (KRPCA)

Julius van Essen
,
David Pfister
,
Axel Heidenreich
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Publication History

Publication Date:
11 March 2015 (online)

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Zusammenfassung

Das kastrationsresistente Prostatakarzinom (KRPCA) ist definiert durch eine PSA-Progression mit oder ohne Metastasennachweis trotz fortgesetzter Androgendeprivation mit LHRH-Analoga/Antagonisten bei Testosteron-Serumkonzentrationen im Kastrationsniveau. In Abhängigkeit der PSA-Verdopplungszeit, der Ansprechdauer auf die vorangegangene Androgendeprivation, die Metastasenlast, die klinische Symptomatik und die Komorbiditäten des Patienten stehen verschiedene immunologische (Sipuleucel-T), hormonelle (Abirateronazetat plus Prednison, Enzalutamid), zytotoxische (Docetaxel) und knochenspezifische (Radium-223) Therapieoptionen zur Verfügung. Alle genannten Optionen führen zu einem ähnlichen statistisch signifikanten Überlebensbenefit gegenüber den Kontrollgruppen. Während die nicht-zytotoxischen Therapieoptionen in erster Linie bei Patienten mit moderater Metastasenlast und fehlender bzw. minimaler Symptomatik indiziert sind, wird Docetaxel bei rascher PSA-Progression, symptomatischer und/oder viszeraler Metastasierung appliziert, während Radium-223 für Patienten mit einer symptomatischen ossären Metastasierung indiziert ist. In der Zweitlinientherapie kommen prinzipiell die identischen oben genannten Therapien in Betracht, unter den zytotoxischen Optionen ist Cabazitaxel zu addieren. Derzeit existiert kein evidenz-basierter Algorithmus der Sequenztherapie, sodass nur ein sehr individueller Therapieplan aufgrund der spezifischen Tumorcharakteristika des Einzelnen erstellt werden kann. Der PSA-Verlauf ist in aller Regel kein idealer Surrogatmarker des therapeutischen Ansprechens und muss durch regelmäßige bildgebende Kontrollen sowie die Bestimmung der Serumkonzentrationen von alkalischer Phosphatase, Albumin, CRP, Hämoglobin und LDH komplettiert werden.

 

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