Introduction. Despite the disappointing statistics of morbidity and mortality rates, prostate cancer is a slow growing tumor and does not always lead to death. Thus, it is of paramountimportance for oncologiststo decidewho should receive aggressive treatment ofrapidly progressing prostate cancer and who should undergo gentle treatment orjust monitoring due to the slowgrowing form of tumor,which isless dangerousfor one’slife. This problem stemsfrom the lack of orfrom the incomplete understanding of prognostic information about the course of the disease from the moment of its diagnosis.
Materials and methods. A retrospective analysis of treating 1127 patients with prostate cancer was conducted. 495 patients received radical prostatectomy (surgical treatment group); 256 patientsreceived combinedX-ray and hormone therapy; 305 patients underwent androgen deprivation, and 71 patients were included into a delayed treatment group with active surveillance and wait-and-see policy. The study included 447 (39.7%) patients with localized prostate cancer, 399 (35.4%) patients with locally advanced prostate cancer and 281 (24.9%) patients with metastatic prostate cancer.
Results. Multi-factor analysisrevealed independent prognostic factorsfor every group,which allowsto predict the further course of the disease.In the group of patients with surgical treatment, oncospecific survival (OS) was mostly affected by metastases to lymph nodes: 5-year and 10-year OS rates dropped to 86.9% and 65.9%,respectively,with 99.4% and 97.5% survivalrates at the N0 stage (p = 0.012). Good somatic status(Charlson index ≤ 1) affected the generalsurvival(GS): 5-year and 10-year GS ratesincreased from 91.4% and 84.2% to 96.2% and 90.2%,respectively (Charlson comorbidity index > 1). In the group of distant X-ray therapy, the longevity of androgen deprivation (36 months) mostly affected the OS (RR = 0.79, CI = 0.61-0.97, p = 0.027); GS was mostly depended on the age of men, under 70 (RR = 0.85, CI = 0.72-0.96, p=0.018). In the group of androgen deprivation, the most crucial factor affecting the OS was the PSA nadir level ≥ 4 ng/ml: 5-year and 10-year OS rates dropped from 56.2% and 5.9% to 28.7% and 0%,respectively (p = 0.004); GS was also affected by the PSA nadir level < 4 ng/ml: 5-year and 10-year GS rates increased from 20.7% and 0% to 39.2% and 2.2%, respectively (p < 0.05). ere were no independent factors affecting the GS rates in the delayed treatment group. e GS values depended on the age of patients: 5-year and 10-year GS rates decreased from 71.2% and 42.3% to 63.1% and 31.6%, respectively (p = 0.031) in patients, who were older than 70. Good somatic status was also a crucial factor (Charlson index ≤ 1): GS rates decreased from 72.5% and 43.2% (with Charlson comorbidity index from 0 to 1) to 62.6% and 31.2%, respectively (p=0.017).
Discussion. The retrospective analysis described in this paper provides a rationale for applying the wait-and-see tactics for a group of patients with nonmetastatic prostate cancer and serious accompanying diseases. is strategy is accounted by high risk of lethality due to the complications caused by accompanying diseases,ratherthan because of prostate cancer. Furtherresearch aimed at the development of a concrete algorithm for active surveillance and waitand-see tactics is being conducted, which therefore implies the right strategy of management of patients with prostate cancer.
Conclusion. e retrospective analysis confirms the effectiveness of surgical, hormonal and combined hormonal andX-ray therapies and provides a rationale for delayed treatment in certain groups of patients. Continuous androgen deprivation therapy (ADT) aer distant X-ray therapy increases the survival rate without PSA recurrence, as well as the general survival. Continuous ADT apparently has various side effects, which affect the metabolic status of menwith high risk of cardiovascular complications.
Authors declarelack of the possibleconflicts of interests.