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Review
. 2023 Apr;62(4):347-353.
doi: 10.1007/s00120-023-02028-1. Epub 2023 Feb 3.

[Diagnosis and staging of metastatic hormone-sensitive prostate cancer]

[Article in German]
Philipp Krausewitz  1 , Manuel Ritter  2 , Markus Essler  3
Affiliations
Review

[Diagnosis and staging of metastatic hormone-sensitive prostate cancer]

[Article in German]
Philipp Krausewitz et al. Urologie. 2023 Apr.

Abstract
in English, German

Background: Risk stratification of patients with metastatic hormone-sensitive prostate cancer (mHSPC) has undergone significant changes in recent years in light of new therapies and innovative imaging.

Objectives: Established and innovative methods for detection of metastasis, risk group stratification, and treatment of mHSPC are outlined and compared.

Materials and methods: Background knowledge and treatment-relevant guideline recommendations on mHSPC are presented and complemented by recent study results.

Results: Integration of modern imaging techniques, especially prostate-specific membrane antigen (PSMA) PET/CT, into the diagnostic algorithm has the potential to significantly improve risk stratification and treatment of mHSPC. By using PSMA PET/CT, metastases are detected early and sensitively. This leads to the definition of new subgroups amenable to modern therapeutic strategies. The prognostic value of using PSMA PET/CT with regard to established risk categories in mHSPC is currently being evaluated.

Conclusions: Modern imaging, especially PSMA PET/CT, has significant added value for the diagnosis and treatment of mHSPC in almost all subgroups. In particular, it helps to select patients who will benefit from intensification or de-escalation of systemic therapy.

Zusammenfassung: HINTERGRUND: Die Risikostratifizierung von Patienten mit metastasiertem hormonsensitivem Prostatakarzinom (mHSPC) hat in den letzten Jahren durch neue Therapieoptionen und innovative Bildgebung einen signifikanten Wandel erfahren.

Ziel der arbeit/fragestellung: Etablierte und innovative Instrumente zur Detektion, Risikogruppenstratifizierung und Behandlung des mHSPC werden dargelegt und gegeneinander abgewogen.

Material und methoden: Hintergrundwissen und behandlungsrelevante Leitlinienempfehlungen zum mHSPC werden veranschaulicht und um aktuelle Studienergebnisse ergänzt.

Ergebnisse: Die Integration moderner Bildgebung, insbesondere der PSMA-PET/CT (prostataspezifisches Membranantigen – Positronenemissionstomographie/Computertomographie), in den diagnostischen Algorithmus hat das Potenzial, die Risikostratifizierung und Therapie des mHSPC wesentlich zu verbessern. Die PSMA-PET/CT erkennt Metastasen frühzeitig und sensitiv und führt dadurch zur Definition neuer Subgruppen, die für moderne Therapiestrategien qualifizieren. Welche prognostische Wertigkeit ihr flächendeckender Einsatz in Bezug auf etablierte Risikokategorisierung beim mHSPC hat, wird aktuell evaluiert.

Schlussfolgerung: Moderne Bildgebung, allen voran die PSMA-PET/CT, hat einen signifikanten Mehrwert für Diagnostik und Therapie des mHSPC in nahezu allen Untergruppen. Insbesondere hilft ihr Einsatz bei der Selektion von Patienten, die von einer Intensivierung oder Deeskalation der Systemtherapie profitieren.

Keywords: Metastasis, neoplasm; PET; PSMA; Recurrence; Risk stratification.

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References

Literatur

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