Testosteron i rak predstatel'noy zhelezy: pravda i vymysel o prostaticheskoy bezopasnosti androgenoterapii


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Abstract

Мифу о том, что тестостерон сам по себе вызывает развитие и прогрессирование рака простаты, исполнилось уже 70 лет.«65-летний миф должен быть развеян, если мы хотим продвинуться дальше в лечении мужчины, в том числе и лечении рака предстательной железы», – так писал в 2006 г. выдающийся оперирующий онкоуролог современности А.Morgentaler, который сегодня имеет самый большой в мире опыт лечения тестостероном мужчин не только после терапии или хирургического лечения рака простаты, но и на фоне нелеченого рака простаты. Результаты его работ опубликованы и доступны всем желающим на соответствующих англоязычных медицинских сайтах.Сегодня в связи с накоплением новых научных данных мы переживаем период переосмысления роли тестостерона в патогенезе заболеваний у мужчин, в том числе и РПЖ [2, 23, 34, 37, 38, 45]. Патофизиологическая взаимосвязь «тестостерон – рак простаты» представляется сложной, но не такой однозначно негативной, как ранее [3, 4, 17, 38, 49, 59].Так, в своей работе J.Massengil и соавт. (2003 г.) показали, что при снижении тестостерона возрастает вероятность экстракапсулярной инвазии опухоли [38].Частота положительных биопсийных находок рака простаты выше среди мужчин с более низким уровнем тестостерона, чем у мужчин с нормальным уровнем, что, скорее всего, обусловлено повышенной экспрессией протоонкогена c-Met в мембранах простатических клеток [3, 4].На сегодняшний день проведен мощный метаанализ 12 исследований (3886 мужчин с РПЖ и 6438 группы контроля), который показал, что нет ассоциации между риском рака простаты и уровнем в крови разных форм тестостерона или эстрогенов [49].

About the authors

S. Yu Kalinchenko

ГБОУ ВПО РУДН, Москва

Кафедра эндокринологии ФПКМР

I. A Tyuzikov

Медицинский Центр диагностики и профилактики-Плюс, Ярославль

Yu. A Tishova

ГБОУ ВПО РУДН, Москва

Кафедра эндокринологии ФПКМР

E. A Grekov

ФГБУ НИИ урологии Минздрава РФ, Москва

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