nefrНефрологияNephrology (Saint-Petersburg)1561-62742541-9439Pavlov First Saint-Petersburg State Medical University10.24884/1561-6274-2009-13-3-153-158nefr-1184Research ArticleЖУРНАЛ В ЖУРНАЛЕ. АКТУАЛЬНЫЕ ПРОБЛЕМЫ УРОЛОГИИJOURNAL IN THE JOURNAL. ACTUAL PROBLEMS OF UROLOGYСОВРЕМЕННЫЕ МЕТОДЫ ЛОКАЛЬНОЙ ТЕРАПИИ РАКА ПРЕДСТАТЕЛЬНОЙ ЖЕЛЕЗЫCURRENT METHODS FOR LOCAL TREATMENT OF PROSTATE CANCERАль-ШукриС. Х.Al-ShukriS. Kh.

кафедра урологии

БоровецС. Ю.BorovetsS. Yu.

кафедра урологии

197022, Санкт-Петербург, ул. Льва Толстого, 6/8, кафедра урологии СПбГМУ им. акад. И.П. Павлова. Тел.: (812) 234-66-57, факс: (812) 234-62-59. 

sborovets@mail.ruРыбаловМ. А.RybalovM. A.

кафедра урологии

СаидовР. Б.SaidovR. B.

кафедра урологии

Санкт-Петербургский государственный медицинский университет им. акад. И.П. ПавловаRussian Federation200910032009133153158Copyright © Аль-Шукри С.Х., Боровец С.Ю., Рыбалов М.А., Саидов Р.Б., 20092009Аль-Шукри С.Х., Боровец С.Ю., Рыбалов М.А., Саидов Р.Б.Al-Shukri S.K., Borovets S.Y., Rybalov M.A., Saidov R.B.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephrolog.ru/jour/article/view/1184

В связи с тем, что развитие методов биопсии и современных методов визуализации (спиральная компьютерная и магнитно-резонансная томография, УЗИ) позволяет всё более точно определять характер роста и локализацию опухоли, возрастает интерес к возможности проведения локальных вмешательств на очагах новообразования в предстательной железе. У 10–50% больных, которым в настоящее время проводится воздействие на всю предстательную железу, включая радикальную простатэктомию, целесообразнее воздействовать только на половину простаты или выполнять локальную терапию отдельных опухолевых очагов. Основными аргументами против локальной терапии считаются возможная невыявленная многоочаговость новообразования, недостаточная точность в определении стадии рака предстательной железы, непредсказуемая агрессивность вторичных очагов и отсутствие единых технологических стандартов данных методик. К потенциальным развивающимся технологиям локальной терапии относят: сфокусированное ультразвуковое излучение высокой интенсивности, криотерапию, радиочастотную абляцию и фотодинамическую терапию. Дальнейшее изучение показаний, эффективности и отдаленных результатов данных методик позволит внедрить их в клиническую практику, после чего станет возможным в ряде случаев отказаться от выполнения радикальной простатэктомии при лечении больных с локализованными формами рака предстательной железы.

Development of biopsy methods and modern means of visualization (spiral computer and magnetic-resonance tomography, ultrasonic examination) allow to define more precisely the character of tumor growth and its localization, in this connection the possibilities of local intervention in the prostate neoplasm foci are of growing interest. At present the intervention is carried out on the whole prostate, including radical prostatectomy, though in 10-50% of patients it is more expedient to influence only a half of the prostate or to perform local therapy of particular tumor foci. The main arguments against local treatment: possibly not revealed multi-focal neoplasm, insufficient accuracy in staging procedure, unpredictable aggressivity of the secondary foci and the absence of common technological standards for these methods. Potential developing technologies of local treatment include focused ultrasonic radiation of high intensity, cryotherapy, radio-frequency ablation and photodynamic therapy. Further study of indications, efficiency and follow-up results of available methods will permit to introduce them into clinical practice, and itwill become possible in some cases to refuse radical prostatectomy when treating patients with localized forms of the prostate gland cancer.

рак предстательной железылечениеметоды локальной терапииprostate gland cancertreatmentmethods of local therapyReferencesCooperberg MR, Lubeck DP, Meng MV et al. The changing face of low-risk prostate cancer: trends in clinical presentation and primary management. J Clin Oncol 2004; 22: 2141–2149Cooperberg MR, Lubeck DP, Meng MV et al. The changing face of low-risk prostate cancer: trends in clinical presentation and primary management. J Clin Oncol 2004; 22: 2141–2149Ahmed HU, Pendse D, Illing R et al. Will focal therapy become a standard of care for men with localized prostate cancer? Nat Clin Pract Oncol 2007; 4: 632–642Ahmed HU, Pendse D, Illing R et al. Will focal therapy become a standard of care for men with localized prostate cancer? Nat Clin Pract Oncol 2007; 4: 632–642Eggener SE, Scardino PT, Carroll PR et al. Focal therapy for localized prostate cancer: a critical appraisal of rationale and modalities. J Urol 2007; 178: 2260–2267Eggener SE, Scardino PT, Carroll PR et al. Focal therapy for localized prostate cancer: a critical appraisal of rationale and modalities. J Urol 2007; 178: 2260–2267Zelefsky MJ, Ben-Porat L, Scher HI, Chan HM, Fearn PA and Fuks ZY et al. Outcome predictors for the increasing PSA state after definitive external-beam radiotherapy for prostate cancer. J Clin Oncol2005; 23: 826Zelefsky MJ, Ben-Porat L, Scher HI, Chan HM, Fearn PA and Fuks ZY et al. Outcome predictors for the increasing PSA state after definitive external-beam radiotherapy for prostate cancer. J Clin Oncol2005; 23: 826D’Amico AV, Chen MH, Roehl KA and Catalona WJ. Preoperative PSA velocity and the risk of death from prostate cancer after radical prostatectomy. N Engl J Med 2004; 351: 125D’Amico AV, Chen MH, Roehl KA and Catalona WJ. Preoperative PSA velocity and the risk of death from prostate cancer after radical prostatectomy. N Engl J Med 2004; 351: 125Goto Y, Ohori M, Arakawa A, Kattan MW, Wheeler TM, Scardino PT. Distinguishing clinically important from unimportant prostate cancers before treatment: value of systematic biopsies. J Urol 1996; 156: 1059Goto Y, Ohori M, Arakawa A, Kattan MW, Wheeler TM, Scardino PT. Distinguishing clinically important from unimportant prostate cancers before treatment: value of systematic biopsies. J Urol 1996; 156: 1059Tsuzuki T, Hernandez DJ, Aydin H, Trock B, Walsh PC, Epstein JI. Prediction of extraprostatic extension in the neurovascular bundle based on prostate needle biopsy pathology, serum prostate specific antigen and digital rectal examination. J Urol 2005; 173: 450Tsuzuki T, Hernandez DJ, Aydin H, Trock B, Walsh PC, Epstein JI. Prediction of extraprostatic extension in the neurovascular bundle based on prostate needle biopsy pathology, serum prostate specific antigen and digital rectal examination. J Urol 2005; 173: 450Naya Y, Slaton JW, Troncoso P, Okihara K and Babaian RJ. Tumor length and location of cancer on biopsy predict for side specific extraprostatic cancer extension. J Urol 2004; 171: 1093Naya Y, Slaton JW, Troncoso P, Okihara K and Babaian RJ. Tumor length and location of cancer on biopsy predict for side specific extraprostatic cancer extension. J Urol 2004; 171: 1093Kestin LL, Goldstein NS, Vicini FA and Martinez AA. Percentage of positive biopsy cores as predictor of clinical outcome in prostate cancer treated with radiotherapy. J Urol 2002; 168: 1994Kestin LL, Goldstein NS, Vicini FA and Martinez AA. Percentage of positive biopsy cores as predictor of clinical outcome in prostate cancer treated with radiotherapy. J Urol 2002; 168: 1994Polascik TJ, Mouraviev V. Focal therapy for prostate cancer. Curr Opin Urol 2008 May; 18(3): 269-74Polascik TJ, Mouraviev V. Focal therapy for prostate cancer. Curr Opin Urol 2008 May; 18(3): 269-74Chaussy C, Thuroff S. The status of high-intensity focused ultrasound in the treatment of localized prostate cancer and the impact of a combined resection. Curr Urol Rep 2003; 4: 248–252Chaussy C, Thuroff S. The status of high-intensity focused ultrasound in the treatment of localized prostate cancer and the impact of a combined resection. Curr Urol Rep 2003; 4: 248–252Blana A, Walter B, Rogenhofer S, Wieland WF. High-intensity focused ultrasound for the treatment of localized prostate cancer: 5-year experience. Urology 2004; 63: 297–300Blana A, Walter B, Rogenhofer S, Wieland WF. High-intensity focused ultrasound for the treatment of localized prostate cancer: 5-year experience. Urology 2004; 63: 297–300Thueroff S, Knauer K, Chaussy C. 10 years high intensity focused ultrasound (HIFU) as local treatment of prostate cancer: profile of side effect. J Urol 2006; 175 [Suppl l]: 364Thueroff S, Knauer K, Chaussy C. 10 years high intensity focused ultrasound (HIFU) as local treatment of prostate cancer: profile of side effect. J Urol 2006; 175 [Suppl l]: 364Poissonnier L, Chapelon JY, Rouviere O et al. Control of prostate cancer by transrectal HIFU in 227 patients. Eur Urol 2007; 51: 381–387Poissonnier L, Chapelon JY, Rouviere O et al. Control of prostate cancer by transrectal HIFU in 227 patients. Eur Urol 2007; 51: 381–387Spikes J.D. The origin and the meaning of the term «photodynamic» (as used in «photodynamic» therapy, for example). J. Photochem. Photobiol. 1991; 9: 369-374Spikes J.D. The origin and the meaning of the term «photodynamic» (as used in «photodynamic» therapy, for example). J. Photochem. Photobiol. 1991; 9: 369-374Zisman A, Leibovici D, Siegel YI and Lindner A. Prostate cryoablation without an insertion kit using direct transperineal placement of ultrathin freezing probes. Tech Urol 2000; 6: 34–36Zisman A, Leibovici D, Siegel YI and Lindner A. Prostate cryoablation without an insertion kit using direct transperineal placement of ultrathin freezing probes. Tech Urol 2000; 6: 34–36Zisman A, Pantuck AJ, Cohen JK and Belldegrun AS. Prostate cryoablation using direct transperineal placement of ultrathin probes through a 17-gauge brachytherapy template-technique and preliminary results. Urology 2001; 58: 988–993Zisman A, Pantuck AJ, Cohen JK and Belldegrun AS. Prostate cryoablation using direct transperineal placement of ultrathin probes through a 17-gauge brachytherapy template-technique and preliminary results. Urology 2001; 58: 988–993Han KR, Belldegrun AS. Third-generation cryosurgery for primary and recurrent prostate cancer. BJU Int 2004; 93: 14–18Han KR, Belldegrun AS. Third-generation cryosurgery for primary and recurrent prostate cancer. BJU Int 2004; 93: 14–18Langenhuijsen JF, Broers EM, Vergunst H. Cryosurgery for Prostate Cancer: an Update on Clinical Results of Modern Cryotechnology. Eur Urol 2009; 55:76-86Langenhuijsen JF, Broers EM, Vergunst H. Cryosurgery for Prostate Cancer: an Update on Clinical Results of Modern Cryotechnology. Eur Urol 2009; 55:76-86Han KR, Cohen JK, Miller RJ et al. Treatment of organ confined prostate cancer with third generation cryosurgery: preliminary multicenter experience. J Urol2003; 170: 1126–1130Han KR, Cohen JK, Miller RJ et al. Treatment of organ confined prostate cancer with third generation cryosurgery: preliminary multicenter experience. J Urol2003; 170: 1126–1130Ismail M, Ahmed S, Kastner C, Davies J. Salvage cryotherapy for recurrent prostate cancer after radiation failure: a prospective case series of the first 100 patients. BJU Int 2007; 100: 760–764Ismail M, Ahmed S, Kastner C, Davies J. Salvage cryotherapy for recurrent prostate cancer after radiation failure: a prospective case series of the first 100 patients. BJU Int 2007; 100: 760–764Bahn DK, Silverman P, Lee F et al. Focal prostate cryoablation: Initial results show cancer control and potency preservation. J Endourol 2006; 20 (9): 688–692Bahn DK, Silverman P, Lee F et al. Focal prostate cryoablation: Initial results show cancer control and potency preservation. J Endourol 2006; 20 (9): 688–692Onik G. Rationale for a ‘male lumpectomy,’ a prostate cancer targeted approach using cryoablation: results in 21 patients with at least 2 years of follow-up. Cardiovasc Intervent Radiol 2008; 31: 98–106Onik G. Rationale for a ‘male lumpectomy,’ a prostate cancer targeted approach using cryoablation: results in 21 patients with at least 2 years of follow-up. Cardiovasc Intervent Radiol 2008; 31: 98–106Onik G, Vaughan D, Lotenfoe R, Dineen M, Brady J. «Male lumpectomy»: focal therapy for prostate cancer using cryoablation. Urology 2007; 70: 16Onik G, Vaughan D, Lotenfoe R, Dineen M, Brady J. «Male lumpectomy»: focal therapy for prostate cancer using cryoablation. Urology 2007; 70: 16

The authors declare that there are no conflicts of interest present.