Otto Wolfgang, Wieland Wolf F
Lehrstuhl für Urologie, Klinikum der Universität Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland.
Urologie im Gesundheitsforum, Paracelsusstraße 2, 93053, Regensburg, Deutschland.
Urologe A. 2021 Aug;60(8):1039-1050. doi: 10.1007/s00120-020-01389-1.
The question of what came first-in this case the diagnosis of prostate cancer or its therapy-seems absurd at first glance and is reminiscent of the classic metaphor-like problem that preoccupied the Greek writer Plutarch (45-125). Today it is a matter of course that a reliable diagnosis is made before treating a disease, but this must be viewed as inconsistent in medical history. The beginnings of radical prostatectomy for the treatment of prostate cancer, like the first surgical therapies for kidney and bladder tumors, can be located in the pioneering period of organ surgery in the German Empire (1871-1918). The establishment of this procedure in its current form with larger numbers of cases is in turn thanks to the Nestor of American urology, Hugh Hampton Young, who carried out the first perineal prostatovesiculectomy, which from today's perspective can be described as complete. Although the indication has remained largely unchanged since then, this intervention has undergone extensive changes in recent decades. But how has the diagnosis of prostate cancer developed in this period? Of course, much more dynamic. While the procedure prostatovesiculectomy was already established, development of prostate cancer diagnosis began first slowly in the course of the 20th century, then more dynamically. The following article uses medical (historical) original sources to present not only the basics and further developments of the established and, at the same time, subject to constant intervention in urology, but also the essential developments in the environment of neighboring medical disciplines, for example, think of laboratory medicine, radiology, nuclear medicine or rehabilitation medicine, but especially pathology. Incidentally, it was only these developments that created the basis for the correct setting of indications and the identification of alternatives to radical prostatovesiculectomy.
究竟是先有前列腺癌的诊断还是先有其治疗——在这种情况下——乍一看这个问题似乎很荒谬,让人想起希腊作家普鲁塔克(公元45 - 125年)曾思考过的经典隐喻式问题。如今,在治疗疾病之前进行可靠的诊断是理所当然的事情,但这在医学史上却并非一贯如此。根治性前列腺切除术用于治疗前列腺癌的开端,如同肾脏和膀胱肿瘤的首批外科治疗一样,可以追溯到德意志帝国(1871 - 1918年)器官外科的开创时期。而这种手术以当前形式大量开展则要归功于美国泌尿外科学的元老休·汉普顿·扬,他实施了首例会阴前列腺精囊切除术,从当今的角度来看,这堪称完整的手术。尽管自那时起手术指征大体未变,但近几十年来这种手术方式发生了广泛的变化。那么在此期间前列腺癌的诊断是如何发展的呢?当然,变化要大得多。当前列腺精囊切除术已经确立时,前列腺癌诊断的发展在20世纪最初进展缓慢,之后则更为迅猛。以下文章运用医学(历史)原始资料,不仅呈现了泌尿学中既定且不断受到干预的基础及进一步发展情况,还展示了相邻医学学科领域的重要发展,比如检验医学、放射学、核医学或康复医学,尤其是病理学。顺便提一下,正是这些发展为正确设定手术指征以及确定根治性前列腺精囊切除术的替代方案奠定了基础。