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Lohr ; Horninger et al. Weitere Subgruppenanalysen bleiben abzuwarten. Metastasen im Knochen lassen sich aufgrund des lokal gesteigerten Mineralstoffwechsels durch knochenaffine Radionukliden in Form von Technetium-Phosphatverbindungen erfassen.

Trotz unklarer Datenlage kann tendenziell nach einer fachgerechten Erstbiopsie auch bei der Rebiopsie auf eine Biopsie der Transitionalzone verzichtet werden [Pelzer et al.

MRT verbessert werden. Nach Wullich et al. Welche Regionen sollten dabei rebiopsiert werden? Mellinger ; Mellinger et al.

Befundberichten Situationen abzufragen. Angeschrieben wurden randomisiert Urologen aus ganz Deutschland. Darin enthalten sind 4 hypothetische klinische Situationen.

Dieser Fragetyp ist z. Ebenso sind die Fragen 8, 13, 16, 19 und 20 dichotom aufgebaut. Dies ist z. Quantitative Fragen Hier werden Zahlen als Antwort eingefordert.

Im Ergebnis lassen sich diese auf einer metrischen Skala darstellen. Der arithmetische Mittelwert ist somit anwendbar.

Fragen dieses Fragetypus sind die Fragen 1 bis 5. Diese Form wurde z. Material und Methoden - 15 - 2. Der Fragebogen beginnt mit einer allgemeinen Erhebung von demografischen Daten.

Auch soll die Anzahl der Stanzzylinder bei Erstbiopsie diskutiert werden. Ein solcher Fall wurde konstruiert, um das Vorgehen deutscher Urologen bei solch einer Problemstellung darzustellen.

Von Interesse war gewesen, zu erfahren, welches Volumen die bei einem positiven Stanzzylinder entnommenen Tumore durchschnittlich besitzen; jedoch konnten die hierzu nur selten gemachten Angaben nicht brauchbar verwendet werden.

Wir wollten von den Urologen wissen, wie oft und wann sie diese veranlassen. Ludwig Rinnab. Zur besseren Veranschaulichung wurden diese statistischen Kennwerte in Form von Excel-Tabellen dargestellt.

Ergebnisse - 19 - 3. Nicht Beantwortet Ergebnisse 3. Im Rahmen der statistischen Auswertung wurde im nachfolgenden Statistikteil dieser Arbeit zuerst auf die Urologen selbst eingegangen.

Die 95 Urologen weisen eine Berufserfahrungsspanne von 6 Monaten bis 38 Jahren auf mit einer durchschnittlichen Berufserfahrung von 13,1 Jahren.

Abbildung 4 zeigt die Berufserfahrung der Urologen. Ergebnisse - 22 - 3. Die Darstellung erfolgt in Abbildung 4. Ergebnisse - 23 - 3. Zum besseren Vergleich wurden alle Zahlenangaben in Prozentwerte umgerechnet.

Die grafische Darstellung findet sich in Abbildung 5. Die Zahlenwerte stehen dabei jeweils in Bezug zu den Angaben in Abbildung 6 und werden im Einzelnen in Tabelle 4 dargestellt.

Absolutwerte sind also in Prozentwerte umgerechnet. Biopsie vor 6, 10, 12 oder mehr? Die grafische Darstellung dazu ist in Abbildung 6 wiedergegeben.

Ergebnisse - 27 - 3. Ein Urologe machte keine Angaben grafische Darstellung in Abbildung 8. Ergebnisse - 28 - 3. Die grafische Darstellung findet sich in Abbildung 9.

Ergebnisse - 29 - 3. In den Vorbiopsien wurde kein Karzinom nachgewiesen. Ergebnisse - 30 - 3. Die unter 2. So wurden teilweise Angaben in ml, in cm sowie in Prozentwerten angegeben, so dass eine Verarbeitung uns als nicht sinnvoll erschien.

Die Angaben sind dabei in vier Kategorien unterteilt. Fall 1 3. Bei einem hypothetischen Fall wurden die oben genannten Angaben zu Patient und histopathologischem Befund gemacht.

Zudem wurden teilweise Mehrfachangaben gemacht. Die Auswertung ist nachfolgend in Abbildung 16 dargestellt. Die grafische Darstellung findet sich in Abbildung Ergebnisse - 36 - 3.

Ergebnisse - 37 - 3. Ergebnisse - 38 - Fall 3 3. Insgesamt sind die Angaben von 89 Urologen mit in die Statistik eingeflossen.

Ergebnisse - 39 - 3. Dabei wurden Angaben von 89 Urologen in die Statistik mit einbezogen. Ergebnisse - 40 - Fall 4 3. Ergebnisse - 41 - 3.

Hierzu machten 82 Urologen teilweise Mehrfachangaben. Angaben von 82 Urologen. Zeitmangel vermutet werden.

Diskussion - 43 - 4. So geben auf die Frage nach der Berufserfahrung bzw. Als Konsequenz der Ergebnisse eines umfangreich angelegten systematischen Reviews von Eichler et al.

Dabei muss auch die Zone der Prostata angegeben werden laterale periphere, mittlere periphere, transitionale Zone , aus der die Probe entnommen wurde.

TRUS entnommen werden, wobei diese individuell anzupassen sind. Dies sollte eigentlich bedeuten, dass der Biopsie der Transitionalzone eine eher geringere Bedeutung zukommt.

Die aktuellen Leitlinien nehmen hierzu allerdings keine klare Stellung. Da die Publikation von Pelzer et al.

Djavan et al. Yates et al. Dieses Vorgehen schien den Befragten nicht bekannt zu sein. Abrahamsson ; Andriole ]. Kaplan et al. Castellucci et al.

Choi et al. Bisherige Entwicklungen sind aber vielversprechend. Fallbeispiele 4. Angegeben war jedoch nur der Gesamtscore.

Therapientscheidung auszurichten. Sie kamen daher zu der Empfehlung diesem selektionierten Patientengut mit perineuraler Invasion eine aggressivere Therapie z.

Masieri et al. Aufgrund der aktuellen Datenlage [Gutierrez et al. Diskussion - 56 - ; Masieri et al. Jeon et al.

Der entsprechende Fehler ist im Fragebogen im Anhang allerdings korrigiert. Angaben zu der Fragestellung machten insgesamt 89 Urologen.

Insgesamt 49 Mal wurde eine Rebiopsie, wie von der aktuellen Literatur und den S3-Leitlinien empfohlen, genannt. Hintergrund dieser Frage war es, einen Eindruck zu bekommen, welche weiteren Parameter aus histopathologischen Befundberichten von den befragten Urologen als wichtig erachtet werden.

Wichtig scheint hier die Information zu sein, ob es sich schon um ein cT3 bzw. Gerade bei cT3 bzw. Ebenso wird eine Skelettszintigrafie empfohlen.

In einer vergleichbaren Studie, die von Descazeaud et al. Durch diese Studie konnte gezeigt werden wie wichtig es ist, die aus hochevidenten Studien gewonnene therapeutische Konsequenzen gezielt in Leitlinien zusammenzufassen und daraus Empfehlungen klar zu definieren anhand dieser sich die betroffene Berufsgruppe orientieren kann.

Zusammenfassung - 60 - 5. Dies macht deutlich wie entscheidend eine zielgerichtete Diagnostik und die sich daraus ableitende Therapie ist.

Die Studie hat gezeigt, dass es hinsichtlich dem Vorgehen, z. B bei der Anzahl der entnommenen Stanzzylinder, deutliche Abweichungen zwischen den Urologen gibt und die durch Leitlinien empfohlenen Standards nicht immer konsequent umgesetzt werden.

Ebenso konnte anhand der Fallbeispiele gezeigt werden, wie einige Urologen ihre Therapieentscheidung anhand nicht ausreichender histopathologischer Befunde ausrichten.

Durch diese Studie konnte damit deutlich gezeigt werden, wie wichtig klare Empfehlungen durch Leitlinien sind, und wie deutlich die befragte Gruppe teilweise von diesen abweicht.

Literaturverzeichnis - 61 - 6. Literatur 1. Baseline staging of newly diagnosed prostate cancer: a summary of the literature. J Urol 2.

J Am Med Assoc 3. Chemoprevention of prostate cancer in men at high risk: rationale and design of the reduction by dutasterid of prostate cancer events REDUCE trial.

J Urol 5. Mortality results from a randomized prostate-cancer screening trial. N Engl J Med 6. A study on staging bone scans in newly diagnosed prostate cancer.

Urol Int Literaturverzeichnis 7. Overdiagnosis and overtreatment of early detected prostate cancer. World J Urol 8. Barry MJ.

Early detection and aggressive treatment of prostate cancer; groping in the dark. J Gen Intern Med 9. Perineural invasion is associated with increased relapse after external beam radiotherapy for men with low-risk prostate cancer and may be a marker for occult, high-grade cancer.

Berufsverband Deutscher Pathologen e. Version 1. Antibiotic prophylaxis in urologic procedures: a systematic review.

Eur Urol Repeat biopsy in patients with atypical small acinar proliferation or high grade prostatic intraepithelial neoplasia on initial prostate needle biopsy.

J Urol Architectural patterns of high-grade prostatic intraepithelial neoplasia. Hum Pathol Bostwick DG, Quian J.

High-grade prostatic intaepithelial neoplasia. Mod Pathol Literaturverzeichnis Mendelian inheritance of familial prostate cancer.

Temporarily deferred therapy watchful waiting for men younger than 70 years and low-risk localized prostate cancer in the prostatic-specific antigen era.

J Clin Oncol Longitudinal evaluation of prostate-specific antigen levels in men with and without prostate disease.

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Fallbeispiele 4. Angegeben war jedoch nur der Gesamtscore. Therapientscheidung auszurichten. Sie kamen daher zu der Empfehlung diesem selektionierten Patientengut mit perineuraler Invasion eine aggressivere Therapie z.

Masieri et al. Aufgrund der aktuellen Datenlage [Gutierrez et al. Diskussion - 56 - ; Masieri et al. Jeon et al. Der entsprechende Fehler ist im Fragebogen im Anhang allerdings korrigiert.

Angaben zu der Fragestellung machten insgesamt 89 Urologen. Insgesamt 49 Mal wurde eine Rebiopsie, wie von der aktuellen Literatur und den S3-Leitlinien empfohlen, genannt.

Hintergrund dieser Frage war es, einen Eindruck zu bekommen, welche weiteren Parameter aus histopathologischen Befundberichten von den befragten Urologen als wichtig erachtet werden.

Wichtig scheint hier die Information zu sein, ob es sich schon um ein cT3 bzw. Gerade bei cT3 bzw. Ebenso wird eine Skelettszintigrafie empfohlen.

In einer vergleichbaren Studie, die von Descazeaud et al. Durch diese Studie konnte gezeigt werden wie wichtig es ist, die aus hochevidenten Studien gewonnene therapeutische Konsequenzen gezielt in Leitlinien zusammenzufassen und daraus Empfehlungen klar zu definieren anhand dieser sich die betroffene Berufsgruppe orientieren kann.

Zusammenfassung - 60 - 5. Dies macht deutlich wie entscheidend eine zielgerichtete Diagnostik und die sich daraus ableitende Therapie ist.

Die Studie hat gezeigt, dass es hinsichtlich dem Vorgehen, z. B bei der Anzahl der entnommenen Stanzzylinder, deutliche Abweichungen zwischen den Urologen gibt und die durch Leitlinien empfohlenen Standards nicht immer konsequent umgesetzt werden.

Ebenso konnte anhand der Fallbeispiele gezeigt werden, wie einige Urologen ihre Therapieentscheidung anhand nicht ausreichender histopathologischer Befunde ausrichten.

Durch diese Studie konnte damit deutlich gezeigt werden, wie wichtig klare Empfehlungen durch Leitlinien sind, und wie deutlich die befragte Gruppe teilweise von diesen abweicht.

Literaturverzeichnis - 61 - 6. Literatur 1. Baseline staging of newly diagnosed prostate cancer: a summary of the literature.

J Urol 2. J Am Med Assoc 3. Chemoprevention of prostate cancer in men at high risk: rationale and design of the reduction by dutasterid of prostate cancer events REDUCE trial.

J Urol 5. Mortality results from a randomized prostate-cancer screening trial. N Engl J Med 6. A study on staging bone scans in newly diagnosed prostate cancer.

Urol Int Literaturverzeichnis 7. Overdiagnosis and overtreatment of early detected prostate cancer. World J Urol 8. Barry MJ.

Early detection and aggressive treatment of prostate cancer; groping in the dark. J Gen Intern Med 9. Perineural invasion is associated with increased relapse after external beam radiotherapy for men with low-risk prostate cancer and may be a marker for occult, high-grade cancer.

Berufsverband Deutscher Pathologen e. Version 1. Antibiotic prophylaxis in urologic procedures: a systematic review. Eur Urol Repeat biopsy in patients with atypical small acinar proliferation or high grade prostatic intraepithelial neoplasia on initial prostate needle biopsy.

J Urol Architectural patterns of high-grade prostatic intraepithelial neoplasia. Hum Pathol Bostwick DG, Quian J.

High-grade prostatic intaepithelial neoplasia. Mod Pathol Literaturverzeichnis Mendelian inheritance of familial prostate cancer.

Temporarily deferred therapy watchful waiting for men younger than 70 years and low-risk localized prostate cancer in the prostatic-specific antigen era.

J Clin Oncol Longitudinal evaluation of prostate-specific antigen levels in men with and without prostate disease.

J Am Med Assoc Overuse of imaging for staging low risk prostate cancer. The effectiviness of screening for prostate cancer: a nested case-control study.

Arch Intern Med Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer.

J Am Med Assoc Literaturverzeichnis Active surveillance for early-stage prostate cancer.

Review of the current literature. Cancer Prostatic intraepithelial neoplasia is a risk factor for adenocarcinoma: predictive accuracy in needle biopsies.

What information are urologists extracting from prostate needle biopsy reports and what do they need for clinical managment of prostate cancer?

Prostate biopsy: who, how and when. An update. Can J Urol 1: Prospective evaluation of prostate cancer detected on biopsies 1, 2, 3 and 4: when should we stop?

Diagnostic value of systematic biopsy methods in the investigation of prostate cancer: a systematic review.

Endrizzi J, Seay T. The relationship between early biochemical failure and perineural invasion in pathological T2 prostate cancer. Br J Urol Int Am J Surg Pathol Literaturverzeichnis Prediction of progression following radical prostatectomy.

A multivariate analysis of men with long-term follow-up. Am J Surg Pathol J Nucl Med Krebsinzidenz und im Erfassungsgebiet des Gemeinsamen Krebsregisters.

Prediction of prognosis for prostatic adenocarcinoma by combined histological grading and clinical staging.

Gleason DF. Classification of prostatic carcinoma. Cancer Chemother Rep Literaturverzeichnis Regressive changes after short-term neoadjuvant antihormonal therapy in prostatic carcinoma: the value of Gleason grading.

Pathologe Prognostic role of perineural invasion in prostate biopsy. Actas Urol Esp Can effect of finasteride on prostatie-speficic antigen used to decrease repeat biopsy?

Urology Time trends and characteristics of men choosing watchful waiting for initial treatment of localized prostate cancer: results from CrePSURE.

Harris R, Lohr KN. Preventive Services Task Force. Ann Intern Med Helpap B. Prognosefaktoren des Prostatakarzinoms: Pathologe Screening for prostate cancer: Update experience from the Tyrol study.

Can J Urol Atypicall small acinar proliferation suspicious for malignancy in prostate needle biopsies: clinical significance in 33 cases.

Am J Surg Pathol. Prostate-specific antigen, Gleason sum and clinical T stage for predicting the need for radionuclide bone scan for prostate cancer patients in Japan.

Urol Int Perineural invasion is a prognostic factor for biochemical failure after radical prostatectomy. Mandatory second opinion surgical pathology at a large referral hospital.

Cancer Literaturverzeichnis Prostatic cancer: role of color Doppler imaging in transrectal sonography. Am J Roentgenol Prediction of perineural invasion and its prognostic value in patients with prostate cancer.

Korean J Urol Loch T. Urologe Current practice of Gleason grading of prostate carcinoma.

Virchows Arch Specificity of serum prostatespecific antigen determination in the Finnish prostate cancer screening trial.

Br J Cancer Updated nomogram to predict pathologic stage of prostate cancer given prostate-specific antigen level, clinical stage, ang biopsy Gleason score Partin tables based on cases from to Receiver operating characteristics of the prostate spefific antigen test in an unselected population.

J Med Screen Literaturverzeichnis The histology and prognosis of prostatic cancer. Mistry K, Cable G. Meta-analysis of prostate-specific antigen and digital rectal examination as screening tests for prostate carcinoma.

J Am Board Fam Pract MR techniques for noninvasive diagnosis of prostate cancer. World Health Organization. Geneve, S. Parker C. Active surveillance: towards a new paradigm in the managment of early prostate cancer.

Lancet Oncol 5: A model of the natural history of screen-detected prostate cancer, and thev effect of radical treatment on overall survival.

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