{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T23:15:24Z","timestamp":1788218124267,"version":"build-2803163510"},"reference-count":16,"publisher":"Georg Thieme Verlag KG","issue":"05","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Aktuelle Urol"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>Zusammenfassung<\/jats:title>\n                  <jats:p>Die fokale Therapie des lokalisierten Prostatakarzinoms hat sich in den vergangenen zwei Jahrzehnten von einem experimentellen Ansatz zu einer strukturierten Behandlungsoption innerhalb der risikoadaptierten Prostatakarzinomtherapie entwickelt. Ziel des vorliegenden Beitrags ist eine kritische Standortbestimmung unter Ber\u00fccksichtigung aktueller Leitlinien, Evidenzlage und gesundheits\u00f6konomischer Rahmenbedingungen. Die Einf\u00fchrung der multiparametrischen MRT sowie der MRT-gezielten Fusionsbiopsie hat die pr\u00e4zise Identifikation klinisch signifikanter Indexl\u00e4sionen wesentlich verbessert und damit die technische Grundlage f\u00fcr selektive Ablationsverfahren und seiner Nachsorge geschaffen. Trotz dieser diagnostischen Fortschritte bleibt die Evidenz heterogen. Gro\u00dfe randomisierte Vergleichsstudien fehlen weiterhin. Die bislang gr\u00f6\u00dfte vergleichende Untersuchung (HIFI-Studie) zeigte bei methodischen Limitationen eine onkologische Nichtunterlegenheit gegen\u00fcber der radikalen Prostatektomie bei gleichzeitig besseren funktionellen Ergebnissen. Erste randomisierte Daten (FARP-Studie) wurden bislang lediglich in Kongressform vorgestellt. Im aktuellen Therapiespektrum stehen Active Surveillance, fokale Therapie und radikale Standardverfahren nicht in einem strikt konkurrierenden Verh\u00e4ltnis, sondern bilden ein Kontinuum risikoadaptierter Behandlungsstrategien. W\u00e4hrend Active Surveillance den etablierten Standard bei lokal begrenzten Niedrigrisiko- und Fr\u00fchintermedi\u00e4ren Tumoren darstellt, kann die fokale Therapie bei klar lokalisierbarer, biologisch relevanter Indexl\u00e4sion und hohem Wunsch nach Funktionserhalt eine geeignete Option sein. Voraussetzung f\u00fcr zufriedenstellende Ergebnisse ist eine stringente Patientenselektion unter Einsatz moderner Bildgebung, Fusionsbiopsie und strukturierter Nachsorge mittels Bildgebung. Gleichzeitig bestehen erhebliche strukturelle Fehlanreize: Die pr\u00e4therapeutische Pr\u00e4zisionsdiagnostik ist h\u00e4ufig nicht kostendeckend verg\u00fctet, und auch die station\u00e4re Verg\u00fctung fokaler Verfahren liegt deutlich unter der radikaler Standardtherapien, obwohl hier ein durchaus h\u00f6herer und v.a. patientenzentrierterer Aufwand besteht. Zusammenfassend ist die fokale Therapie heute nicht mehr prim\u00e4r als experimentelles Verfahren zu bewerten, sondern als selektive Erg\u00e4nzung im Sinne einer differenzierten Pr\u00e4zisionsonkologie. Ihre Rolle bleibt indikationsabh\u00e4ngig und erfordert weiterhin hochwertige prospektive Studien sowie ad\u00e4quate strukturelle Rahmenbedingungen.<\/jats:p>","DOI":"10.1055\/a-2915-1395","type":"journal-article","created":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T22:33:56Z","timestamp":1788215636000},"page":"471-478","source":"Crossref","is-referenced-by-count":0,"title":["Fokale Therapie des Prostatakarzinoms in Deutschland: Fortschritt oder Illusion?"],"prefix":"10.1055","volume":"57","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8717-2096","authenticated-orcid":false,"given":"Martin","family":"Schostak","sequence":"additional","affiliation":[{"name":"LOGICURO GmbH, Germany","place":["Potsdam"],"department":["Urooncology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelika","family":"Borkowetz","sequence":"additional","affiliation":[{"name":"Universit\u00e4tsmedizin Rostock, Germany","place":["Rostock"],"department":["Klinik und Poliklinik 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