Prostate cancer (PCA) is a malignant tumor of the genitourinary system in men, the prevalence of which in recent years, reaching epidemic proportions. Innovative methods of diagnosis and treatment of prostate cancer, and accessibility have become Central themes of the VII Moscow urological school, brought together experts not only from the capital, noise the whole country.
Checked or not checked
In the structure of oncological diseases in Russia prostate cancer is second after lung cancer and third in mortality. In most cases the disease is detected in 50-70 years. Prostate cancer is a multifactorial disease, among the risk factors: family history, in which it is possible to ache after 40 years, and takeavenue habits, work in hazardous industries, incorrect diet, lack of exercise, high blood pressure and blood sugar levels, poor environment. And, then, from this scourge not insured by any one man.
Meanwhile, in recent years, had questioned the axiom of early diagnosis of cancer screening based on determination of the level of prostate specific antigen (PSA) in serum.The fact that this study gives many false-positive results on the basis of which men are made unnecessary biopsies and even surgeries, and in some countries there have been attempts to abandon this method. However, the results were deplorable in the absence of screening, the incidence of severe forms of cancer increased.
Were the proposal not to treat and just leave under the supervision of men with small and nonaggressive tumors.Five years ago there was a study that showed that the part of the patients do not require therapy, – told the chief urologist Ministry of health and the city of Moscow, head of the urology clinic of the clinical hospital named. Spasokukotskogo, corresponding member of the Russian Academy of Sciences Dmitry Pushkar. But these patients are only 2-3%. However, our people heard the sound, I decided that cancer can’t be treated. So we have a lot of patients in advanced stages of the disease. Russian men over 50 years of age give blood for the study of PSA levels in the framework of the examination. And to neglect this possibility in any case it is impossible, experts say.
Theragnostic
In the modern world, prostate cancer is treatable quite successfully, but in some men, the disease progresses and may be life-threatening. Up to 20% of all cases of prostate cancer is castrate-resistant prostate cancer (CRCG) the activated form of a tumor resistant to castration therapy. Approximately 90% of patients CRRPG bony metastases, which are one of the main causes of death. The problem of therapy CRRPG very important for the Russian oncourology quite often patients come to the doctor with advanced forms of cancer, says Pushkar.
According to him, in prostate cancer there are micrometastases in the liver, bones, lymph nodes, which doctors can’t find, though I know that they are. Until recently, diagnostic methods that could detect scattered throughout the body cancer cells do not exist. But now there’s a special radionucleide research methods charged alpha particles they are found. Moreover it is possible to do therapeutic charges, which deliver drugs directly to sick cells and help kill them. Such targeted therapy allows us to deal not only with the revealed but with the hidden pathological lesions. There was even a new definition theragnostics, involving both therapy and diagnostics, told the chief urologist of the country.
Radionuclide therapy
In the last 15 years significant progress has been made in the treatment of metastatic CRRPG. There are a number of drugs for systemic therapy, will increase the lifespan: hormonal therapy, cytotoxic chemotherapy and radionuclide therapy. These methods are not mutually exclusive, on the contrary, the consistent application of a greater number of drugs with different mechanisms of action allows to achieve the best result.
Radionuclide therapy is a method of treatment of oncological diseases that influence on the foci from the inside.That is, the radiation effect is not due to external radiation, as in conventional external beam radiotherapy, and by introducing directly into the patient radiopharmaceutical preparation containing a therapeutic radionuclide. The foci are purposeful impact from the inside out, with minimal damage to healthy tissues. In Russia are used radiopharmaceuticals isotopes of strontium and samarium, which are beta emitters. However, this method has a significant disadvantage: due to the relatively long run of beta particles in tissues is the use of these isotopes has a negative effect on the bone marrow.
Targeted alphatherapy
Today all over the world conducting research on the use of other radiopharmaceuticals for therapy of patients with bone metastases. Recently in Russia for the treatment of such patients applied to alpha-emitters on the basis of isotope of radium. This is the most modern method of radionuclide therapy called targeted alpha therapy. Targeted alpha therapy allows the directional impact on the neoplastic process by suppressing not only be identified but also hidden pathological lesions.
Alpha emitters are introduced into the patient by intravenous injection. The isotope of radium, due to its chemical similarity with calcium, is actively embedded in bone metastases and by acting on the tumor cells and the microenvironment provides anti-tumor effect. This allows not only to reduce pain but also to suppress tumor growth. In contrast to beta emitters, the previous generation, targeted alpha therapy has a high selectivity of the impact, with minimal damage to hematopoietic cells, – explained the head. Department of radiosurgical treatment with open radionuclides, MRRC them. Tsyba (branch SMRC radiology Ministry of health of Russia), Ph. D. Valery Krylov. And the treatment can be performed on an outpatient basis.
Today this technology is available in more than 50 countries and has managed to confirm the increased survival of patients. Unfortunately, in Russia the coverage of targeted alpha therapy minimum less than 1% of patients, said Pushkar. But the professional community has high hopes for more active dissemination.
Irina Reznik