Lysenko V. The prognosis of prostate cancer clinical course by polyfocal prostate biopsy assessment in dynamics

The thesis covers a new method of monitoring and prognosis of the prostate cancer clinical course based on assessment of immunohistochemical tumor markers and posttreatment morphological changes in dynamic polyfocal biopsy speciment. This paper presents the results of morphological examination of 102 patients with primary prostate adenocarcinoma who had different clinical stages of the disease. 60 of them were randomized after radiation, hormonal or hormonal-radiation therapy and were made the dynamic transrectal polyfocal prostate biopsy in 3, 6 and 9 months after treatment. It was established that high expression of Ki67, IGF, PCNA and low expression of AR and E-cadherin were associated with a poor prognosis (p < 0.001- 0.05), but P53 expression was not significant for prostate cancer clinical course (p = 0.52). It was found that 43.3% prostate cancer patients had the potencially aggressive tumor in speciment of dynamic polyfocal prostate biopsy in 6-9 months after treatment despite normal data of serum PSA, TRUS, DRE. All these patients had posttreatment pathomorphosis II or III degrees. While the structural changers of IV degree were associated with remission of the disease in 100% cases. The patients having III degree of posttreatment pathomorphosis had a practically equal possibility of prostate cancer progression or remission and study of Ki67, IGF, PCNA expression in dynamic biopsy speciment allowed to differentiate the patients who need more active treatment. The specifity of this monitoring method in assessment of the risk of the progression is 84% and the sensitivity - 100%.The monitoring and prognosis of the prostate cancer disease by dynamic transrectal polyfocal biopsy in 6 months оf the treatment allow to assess the effectiveness of the primary therapeutic method, to change the treatment tactics if nessesary and is not accompanied by increasing amount of complication and does not result in tumor dissemination.