Эволюция представлений о роли тестостерона при раке предстательной железы. Обзор литературы

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Андрология и генитальная хирургия. 2022; 23: 26-35

Эволюция представлений о роли тестостерона при раке предстательной железы. Обзор литературы

Ахвледиани Н. Д., Бабаев М. У., Соловьев В. В.

https://doi.org/10.17650/2070-9781-2022-23-4-26-35

Аннотация

Введение. Рак предстательной железы – одно из самых частых онкологических заболеваний у мужчин. Представления о роли основного мужского гормона – тестостерона – в генезе карциномы предстательной железы кардинально менялись за последние два с лишним века.

Цель исследования – проанализировать эволюцию взглядов на взаимосвязь тестостерона и рака предстательной железы и оценить ее влияние на организацию медицинской помощи.

Материалы и методы. Поиск публикаций осуществлялся в Национальной медицинской библиотеке США и Центральной научной медицинской библиотеке Российской Федерации по ключевым словам: рак предстательной железы, тестостерон. Учитывались только оригинальные публикации и метаанализы. В итоге было отобрано 59 публикаций и проведен их описательный анализ.

Результаты. Представлены сведения о сомнительности отрицательной роли тестостерона в канцерогенезе рака предстательной железы ввиду малого числа наблюдений и многочисленных методологических дефектов проведенных исследований. Обозначена доказательность теории андрогенного насыщения при карциономе предстательной железы, которая основана на работах с достаточным количеством наблюдений. Описаны исследования, подтверждающие отсутствие канцерогенного влияния андрогензаместительной терапии у здоровых индивидов и прогрессии опухолевого процесса на фоне назначения тестостерона после лечения онкологического процесса. Более того, приведены сведения о применении указанного гормона при лечении кастрационно-резистентной формы карциномы предстательной железы.

Заключение. С течением времени появляется все больше данных, которые подтверждают протективную роль тестостерона в отношении развития и даже при лечении рака предстательной железы. В связи с этим возникает перспектива глобальной трансформации организации медицинской помощи в вопросах тактики ведения больных карциномой предстательной железы, а также в целом мужчин старших возрастных групп. Очевидной остается необходимость проведения новых более качественных исследований по указанному вопросу.

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Andrology and Genital Surgery. 2022; 23: 26-35

Evolution of the views on the role of testosterone in prostate cancer. Literature review

Akhvlediani N. D., Babaev M. U., Solovyev V. V.

https://doi.org/10.17650/2070-9781-2022-23-4-26-35

Abstract

Background. Prostate cancer is one of the most common cancers in men. The views on the role of the main male hormone, testosterone, in the genesis of prostate carcinoma has changed dramatically over the last two centuries.

Aim. To study the evolution of views on the relationship between testosterone and prostate cancer and to assess their impact on the organization of medical care.

Materials and methods. Publications were searched in the National Library of Medicine of the United States and the Central Scientific Medical Library of the Russian Federation using the keywords: prostate cancer, testosterone. Only original publications and meta-analyses were considered. As a result, 59 publications were selected and their descriptive analysis was performed.

Results. The information aboutthe doubtfulness ofthe negative role oftestosterone in genesis of prostate cancer is presented, taking into account the small number of observations and numerous methodological defects of the studies. The evidence for the theory of androgenic saturation in prostate carcinoma is outlined, which is based on publications with a sufficient number of publications. Studies confirming the absence of a carcinogenic effect of androgen replacement therapy in healthy individuals and progression of the tumor process on testosterone administration after treatment of the cancer process are described. Moreover, there is information on the use of this hormone in the treatment of castration-resistant prostate carcinoma.

Conclusion. Over time, there is increasing evidence for the protective role of testosterone in the development and even treatment of prostate cancer. This raises the prospect of a global transformation in the organization of medical care in the management of patients with prostatic carcinoma, as well as older men in general. There is a clear need for new and better research on this issue.

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