TREATMENT AND EVALUATION OF THE RESULTS OF TREATMENT OF ELDERLY PATIENTS WITH HIGH-RISK PROSTATE CANCER WHO RECEIVED RADIATION THERAPY ACCORDING TO A RADICAL PROGRAM. CYCLE OF CLINICAL CASES

ABSTRACT. Prostate cancer (PCa) occupies one of the first places in the structure of oncological morbidity in the male population in economically developed countries. Active treatment mostly benefits patients with high-risk PCa and high life expectancy. The average life expectancy of men in in Ukraine is 66.8 years, according to 2021 data. PCa Clinical protocols do not provide unequivocal recommendations for choosing the optimal treatment tactics. For high risk PCa patients the radiation therapy should be accompanied by androgen deprivation for a long period of time (2-3 years), according to the NCCN and the European Association of Urologists. Also, there are no recommendations regarding the final control points of discontinuation ADT, and regarding the end points of prostate cancer treatment. Study of the interaction of the prostate-specific antigen (PSA) level with the expression of the androgen receptor (AR), the iьmunohistochemical index of cell proliferation Ki-67 and the expression of the anti-apoptotic protein BCL-2 in prostate tissues of patients, who received radical radiation treatment in combination with adjuvant ADT may be a relevant topic of research. The study included 3 elderly patients with high-risk prostate received radical radiotherapy for high-risk prostate cancer. Evaluation of the oncological effectiveness of treatment was carried out based on the PSA data, CT oncoscreening and repeated biopsy of the prostate (to determine the therapeutic pathomorphism and expression of immunohistochemical markers AR, Ki-67 and BCL-2. CLINICAL CASES. Patient B. Born in 1943, PSA total baseline — 45.8 ng/ml, T2cN0M0. Pathomorphological examination data (PMD): G3 adenocarcinoma (AC) of acinar-solid structure, Gleason 3+5=8 points. The patient was prescribed ADT with analogues of LHRH. TUR was performed (PSA 0.748 ng/ml) with subsequent radiation therapy. The patient administrated ADT with analogues of LHRH for 18 months after the radiation therapy. The patient underwent repeated MFB of the prostate gland. PMD results: G2 AK of acinar structure, therapeutic pathomorphosis (TP) grade III. IGH assay results: AR and BCL-2 expression absent, KI-67 3%. A decision was made to withdraw ADT, based on results of IGH assay. PSA for the 48th month of observation was 0.006 ng/ml. Patient G. Born in 1946, PSA baseline — 129 ng/ml, T2cN0M0. PMD data: G2 АС of small acinar structure, Gleason 3+4=7 points. The patient was prescribed ADT with analogues of LHRH. TUR was performed (PSA 3.06 ng/ml) followed by radiation therapy. Due to the development of bladder neck stricture, the patient underwent repeated TUR biopsy of the bladder neck stricture (18 month follow-up, PSA 0.02 ng/ml). Results of PMD: G3 AK of acinar-solid structure, TP grade III, Gleason 4+4=8 points. IGH assay results: AR expression 70%; BCL-2 10%, KI-67 15%. A decision was made to prescribe abiraterone at a dose of 1000 mg per day, based on results of IGH assay. Patient Sh. 1944, PSA total baseline — 22 ng/ml, T2cN0M0. PMD data: G2 AC of small acinar structure, Gleason 3+4=7 points. The patient underwent operative treatment — of bilateral orchiectomy, after 24 months followed by radiation therapy. PSA to 13.5 ng/ml, repeated MFB of the prostate was performed. PMD results: small fragments of prostate AC. IGH data: AR 95%, Ki-67 15%, BCL-2 50%. A decision was made to perform a radical prostatectomy, based on results of IGH assay. PMD: acinar AC of the prostate Gleason 3+4=7, G2, pT2c, N0, R0. CONCLUSIONS. IGH receptors expression can be an additional diagnostic tool for decision-making regarding the further tactics of special treatment in patients with non-metastatic prostate cancer who have received radical radiotherapy and ADT.