Strahlentherapie nach radikaler prostatektomie bei PSA-Anstieg aus dem "nullbereich" ohne histologische sicherung eines lokalrezidivs - Eine kurative therapieoption?

Within 5 years following radical prostatectomy, 15-60% of patients with pT3 prostate carcinoma show increasing or persistently raised PSA values, a sign of local and/or systemic tumor progression. Percutaneous, 3-dimensionally planned local irradiation with a total dose of 60-70 Gy can reduce PSA to the undetectable range again in 30-70%. Of these patients, 40-65% remain within the undetectable level for 2-5 years after radiotherapy. PSA levels should be as low as possible (< 2 ng/ml) when starting radiotherapy. With higher PSA levels, the chance of achieving an undetectable PSA level again decreases to less than 35% of the patients. Severe late side effects of 3-D planned radiotherapy are infrequent (< 3%). Primary hormonal treatment in patients with increased PSA is longterm and only palliative in nature, with a median time to the development of metastases of 4-7 years. This hormonal treatment can also be given after failure of radiotherapy. Taking into consideration that the follow-up periods for patients treated with radiotherapy for increased PSA after radical prostatectomy are too short for final conclusions, it nevertheless appears that radiotherapy may be the only measure with curative potential in selected patients.