Genetik des Prostatakarzinoms
Tóm tắt
Das Prostatakarzinom stellt die häufigste Krebserkrankung und die dritthäufigste Krebstodesursache bei Männern in Europa dar. Die Möglichkeiten der Behandlung und Früherkennung des Prostatakarzinoms nahmen in den letzten Jahren deutlich zu. Von großer Wichtigkeit ist dabei auch die Identifizierung von Patientengruppen, die ein besonders hohes Risiko haben, ein Prostatakarzinom zu entwickeln, um sie einem gezielten, intensivierten Früherkennungsprogramm zuzuführen. Es wird vermutet, dass bei etwa 10 % der Männer genetische Ursachen im Rahmen eines monogen vererbten Tumorsyndroms für die Entstehung des Prostatakarzinoms verantwortlich sind. Die am häufigsten mit Prostatakarzinom in Verbindung gebrachten Gene sind BRCA1, BRCA2 und HOXB13, die zusammengenommen etwa 40 % der genetisch bedingten Prostatakarzinome verursachen. Daneben wird der Einfluss zahlreicher anderer Gene, wie u. a. der sog. Lynch-Syndrom-Gene, diskutiert. Mutationen der BRCA1- und BRCA2-Gene haben auch einen bedeutenden Einfluss auf die Eigenschaften, die Prognose und den Verlauf des Prostatakarzinoms. Des Weiteren gibt es Hinweise dafür, dass Prostatakarzinome basierend auf BRCA-Keimbahnmutationen, ähnlich wie bei Brust- und Eierstockkrebs, besser auf platinbasierte Therapien ansprechen. Auch neue Therapien, wie PARP-Inhibitoren, könnten zukünftig in bestimmten Fällen zum Einsatz kommen. In jedem Fall ermöglicht der Nachweis einer familiären Mutation bei einem Prostatakarzinompatienten eine prädiktive Testung von Angehörigen zur Beurteilung des individuellen Tumorrisikos mit der Möglichkeit einer engmaschigen Früherkennung für Hochrisikopersonen und der Entlastung jener, die die Mutation nicht geerbt haben.
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