The dissertation is devoted to the improvement of the quality of medical care for patients with clinically locally advanced prostate cancer (PCa). The method of prognosis the course of clinically locally-advanced PCa was developed. We retrospectively analysed data of 213 patients with locally-advanced and localized high risk PCa, who underwent radical prostatectomy (RPE) between 2002 and 2015. All the patients were randomized into 2 groups: a study group of 106 patients with clinically locally advanced PCa and a control group of 107 patients with clinically localized high risk PCa by D'Amico. For the study of Hsp60 heat shock proteins as prognostic markers of PCa, 55 patients with PCa were analyzed additionally. 70 healthy blood donors were used as control group the expression of Hsp60. In study and control group the rate of biochemical recurrence were 51.9% and 47.7% , 5-year biochemical reccurence free survival - 47.7% and 53.8% (p=0.329), 5-year cancer specific survival - 85.8% and 89.4% (p=0.739), respectively. During the follow-up 55 (51.9%) patients with the locally-advanced PCa experienced biochemical recurrence, 18 died, with 16 dying of PCa. All the patients of the study group were devided into three different risk groups based on the number of adverse factors present. Low risk patients had PSA level <20 ng/ml, biopsy Gleason score 6 and absence of the seminal vesicle invasion of cancer (14 patients). Intermediate risk was noted when the patient had only one of poor prognostic factors (PSA more 20 ng/ml or biopsy Gleason score 7 and higher or presence of cancer invasion to the seminal vesicle, 35 patients) and high risk patients had 2 or 3 poor prognostic factors (53 patients). The using of such prognostic stratification, demonstrated a different frequency of biochemical recurrence in three groups of prognosis: 14.3% in the low risk, 37.1% in the intermediate risk (OR 3.0; 95% CI, 1.4-6.3) and 70.1% in high risk groupe (OR 8,5: 95% CI, 4.0-17.9) (p=0.0001).It is proved that with an increasing of the number of poor pathomorphological findings in patients with clinically locally advanced PCa, the risk of recurrence and cancer-specific mortality increases. Thus, in the presence of one pathomorphological adverse factor, the risk of biochemical recurrence increases in 5.6, two - in 12.8, three - in 36.0, four - in 30.0 times. The risk of the death from PCa in case of the presence of one factor increases in 1.3, two - in 28.0, three - in 18.9, four - in 22.7 times. The role of heat shock proteins Hsp60 in cancerogenesis of PCa was proved. The level of Hsp60's antibodies expression in patients with prostate cancer was hugher than in control group. No statistically significant association was found between Hsp60's antibodies level and prognostic clinical parameters, such as stage of PCa, PSA level, Gleason score. The highest levels of anti-Hsp60 antibodies in serum were observed among patients with an aggressive course of the disease.
