medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2026-151medsovet-10002Research ArticleОНКОУРОЛОГИЯONCOUROLOGYПобочные эффекты андрогенной депривации при раке предстательной железы и способы их коррекции: систематический обзорSide effects of androgen deprivation in prostate cancer and their correction: Systematic reviewhttps://orcid.org/0000-0003-0813-6386СавинЛ. Т.SavinL. T.

Савин Леонид Тарасович, аспирант кафедры урологии и оперативной нефрологии с курсом онкоурологии; врач-уролог

117997, Москва, ул. Большая Серпуховская, д. 27; 117198, Москва, ул. Миклухо-Маклая, д. 6

Leonid T. Savin, Postgraduate Student of the Department of Urology and Operative Nephrology with a course in Oncourology; Urologist

27, Bolshaya Serpukhovskaya St., Moscow, 117997; 6, Miklukho-Maklai St., Moscow, 117198

savleonssavin@yandex.ruhttps://orcid.org/0009-0009-6530-8309БалашоваК. Д.BalashovaK. D.

Балашова Ксения Денисовна, студент

119048, Москва, ул. Трубецкая, д. 8, стр. 2

Ksenia D. Balashova, Student of the Federal State Autonomous Educational Institution of Higher Education

8, Bldg. 2, Trubetskaya St., Moscow, 119048

balashova.kd@gmail.comhttps://orcid.org/0000-0002-3646-1664БайтманТ. П.BaitmanT. P.

Байтман Татьяна Павловна, к.м.н., научный сотрудник отделения урологии; ассистент кафедры урологии и оперативной нефрологии с курсом онкоурологии

117997, Москва, ул. Большая Серпуховская, д. 27; 117198, Москва, ул. Миклухо-Маклая, д. 6

Tatiana P. Baitman, Cand. Sci. (Med.), Researcher at the Department of Urology; Assistant at the Department of Urology and Operative Nephrology with a course in Urology Oncology

27, Bolshaya Serpukhovskaya St., Moscow, 117997; 6, Miklukho-Maklai St., Moscow, 117198

bit.t@mail.ruhttps://orcid.org/0009-0008-6626-761XБорукаевА. Ю.BorukaevA. Y.

Борукаев Андемиркан Юриевич, аспирант, врач-уролог

117997, Москва, ул. Большая Серпуховская, д. 27

Andemirkan Y. Borukaev, Graduate Student, Urologist

27, Bolshaya Serpukhovskaya St., Moscow, 117997

antik.bor98@gmail.comhttps://orcid.org/0000-0002-6481-4463АхмадеевЗ. Р.AkhmadeevZ. R.

Ахмадеев Загир Рустамович, врач-онколог, Республиканский клинический онкологический диспансер

450054, Уфа, Проспект Октября, д. 73/1

Zagir R. Akhmadeev, Oncologist

73/1, Oktyabrya Ave., Ufa, 450054

z.ahmadeev@gmail.comhttps://orcid.org/0000-0003-4513-5438СавинаА. А.SavinaA. A.

Савина Анна Алексеевна, врач-патологоанатом

117997, Москва, ул. Большая Серпуховская, д. 27

Anna A. Savina, Pathologist

27, Bolshaya Serpukhovskaya St., Moscow, 117997

savanna070898@gmail.comhttps://orcid.org/0000-0002-9676-1802МонаковД. М.MonakovD. M.

Монаков Дмитрий Михайлович, к.м.н., старший научный сотрудник отделения онкоурологии и урологии; доцент кафедры урологии и оперативной нефрологии с курсом онкоурологии

117997, Москва, ул. Большая Серпуховская, д. 27; 117198, Москва, ул. Миклухо-Маклая, д. 6

Dmitry M. Monakov, Cand. Sci. (Med.), Senior Researcher at the Department of Oncourology and Urology; Associate Professor of the Department of Urology and Operative Nephrology with a Course of Oncourology

27, Bolshaya Serpukhovskaya St., Moscow, 117997; 6, Miklukho-Maklai St., Moscow, 117198

gvkg-monakov@mail.ruhttps://orcid.org/0000-0002-0086-869XГрицкевичЕ. Ю.GritskevichE. Yu.

Грицкевич Елена Юрьевна, к.м.н., заместитель директора по медицинской части

143581, Московская обл., д. Аносино, ул. Санаторная, д. 7

Elena Yu. Gritskevich, Cand. Sci. (Med.), Deputy Director for Medical Affairs

7, Sanatornaya St., Anosino Village, Moscow Region, 143581

genyan.7@mail.ruhttps://orcid.org/0000-0002-8461-9243ИзмайловА. А.IzmailovA. A.

Измайлов Адель Альбертович, д.м.н., главный врач; доцент кафедры урологии и онкологии

450054, Уфа, Проспект Октября, д. 73/1; 450008, Республика Башкортостан, Уфа, ул. Ленина, д. 3

Adel A. Izmailov, Dr. Sci. (Med.), Chief Physician; Associate Professor, Department of Urology and Oncology

73/1, Oktyabrya Ave., Ufa, 450054;3, Lenin St., Ufa, Republic of Bashkortostan, 450008

izmailov75@mail.ruhttps://orcid.org/0000-0002-5160-925XГрицкевичА. А.GritskevichA. A.

Грицкевич Александр Анатольевич, д.м.н., доцент, профессор РАН, заведующий отделением онкоурологии и урологии; профессор кафедры урологии и оперативной нефрологии с курсом онкоурологии

117997, Москва, ул. Большая Серпуховская, д. 27; 117198, Москва, ул. Миклухо-Маклая, д. 6

Aleksander A. Gritskevich, Dr. Sci. (Med.), Associate Professor, Professor of the Russian Academy of Sciences, Head of the Department of Oncourology and Urology; Professor of the Department of Urology and Operative Nephrology with a Course of Oncourology

27, Bolshaya Serpukhovskaya St., Moscow, 117997; 6, Miklukho-Maklai St., Moscow, 117198

grekaa@mail.ruНациональный медицинский исследовательский центр хирургии имени А.В. Вишневского; Российский университет дружбы народов имени Патриса ЛумумбыРоссияVishnevsky National Medical Research Center of Surgery; RUDN UniversityRussian FederationПервый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет)РоссияSechenov First Moscow State Medical University (Sechenov University)Russian FederationНациональный медицинский исследовательский центр хирургии имени А.В. ВишневскогоРоссияVishnevsky National Medical Research Center of SurgeryRussian FederationРеспубликанский клинический онкологический диспансерРоссияRepublican Clinical Oncology DispensaryRussian FederationСанаторий работников органов прокуратуры Российской Федерации «Истра»РоссияSanatorium of Employees of the Prosecutor’s Office of the Russian Federation “Istra”Russian FederationРеспубликанский клинический онкологический диспансер; Башкирский государственный медицинский университетРоссияRepublican Clinical Oncology Dispensary; Bashkir State Medical UniversityRussian Federation20262904202600Online First10002Copyright © Савин Л.Т., Балашова К.Д., Байтман Т.П., Борукаев А.Ю., Ахмадеев З.Р., Савина А.А., Монаков Д.М., Грицкевич Е.Ю., Измайлов А.А., Грицкевич А.А., 20262026Савин Л.Т., Балашова К.Д., Байтман Т.П., Борукаев А.Ю., Ахмадеев З.Р., Савина А.А., Монаков Д.М., Грицкевич Е.Ю., Измайлов А.А., Грицкевич А.А.Savin L.T., Balashova K.D., Baitman T.P., Borukaev A.Y., Akhmadeev Z.R., Savina A.A., Monakov D.M., Gritskevich E.Y., Izmailov A.A., Gritskevich A.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/10002Введение

Введение. Современные варианты терапии местнораспространенного и метастатического рака предстательной железы позволяют достичь высоких показателей выживаемости, в связи с чем на первый план выходят вопросы качества жизни и коррекции сопутствующих заболеваний, нередко становящиеся основной причиной летальности пациентов этой когорты. Метаболические нарушения являются одним из наиболее частых нежелательных побочных эффектов андрогендепривационной терапии. В настоящее время описаны различные варианты их коррекции, однако не предложена единая стратегия.

Цель

Цель. Актуализировать и систематизировать современные данные о патогенезе метаболических нарушений, индуцированных андрогендепривационной терапией, и провести анализ мультидисциплинарных подходов к их коррекции.

Материалы и методы

Материалы и методы. Проведены поиск, анализ и систематизация релевантных публикаций в базах данных PubMed, Google Scholar, elibrary.ru и cyberleninka.ru с использованием следующих ключевых слов: «рак предстательной железы», «андрогендепривационная терапия», «метаболические нарушения», «саркопения», «остеопороз», «инсулинорезистентность». Исключены тезисы конференций и авторефераты диссертаций, комментарии редакции. В результате из 158 публикаций отобрано 79, включенных в настоящий обзор. Для написания введения использованы 19 источников, 60 источников использованы при написании основной части, 7 источников, указанных ранее в основной части, – для написания обсуждения.

Результаты

Результаты. На основании обзора нами предложены рекомендации по дообследованию больных раком предстательной железы, получающих андрогендепривационную терапию, а также представлены перспективные подходы, позволяющие снижать метаболические нарушения и повышать онкоспецифическую выживаемость. Так, агонисты рецепторов глюкагоноподобного пептида-1 и статины способны не только корригировать метаболические нарушения, но и влиять на канцерогенез. Ингибиторы RANKL также обладают двойным действием, разрывая порочный круг костной резорбции при метастазах. Доказано положительное влияние физической активности и коррекции питания на качество и продолжительность жизни данной когорты пациентов. Модификации андрогендепривационной терапии путем применения интермиттирующего режима или использования антагонистов рилизинг-гормонов также позволяет снизить риск метаболических осложнений.

Выводы

Выводы. Комплексный подход к наблюдению и терапии способствует увеличению качества и продолжительности жизни пациентов с раком предстательной железы, получающих андрогендепривационную терапию, а также улучшению результатов системной противоопухолевой терапии.

Introduction

Introduction. Current treatment options for locally advanced and metastatic рrostate cancer offer high survival rates, making quality of life and management of comorbidities, which are often the primary cause of mortality in this cohort, a priority. Metabolic disturbances are one of the most common adverse effects of androgen deprivation therapy. Various treatment options have been described, but no single strategy has been proposed.

Aim

Aim. To update and systematize modern data on the pathogenesis of metabolic disorders induced by androgen deprivation therapy, and to analyze multidisciplinary approaches to their correction.

Materials and methods

Materials and methods. A search, analysis, and systematization of relevant publications were conducted in the PubMed, Google Scholar, elibrary.ru, and cyberleninka.ru databases using the following keywords: “prostate cancer” “androgen deprivation therapy”, “metabolic disorders”, “sarcopenia”, “osteoporosis”, and “insulin resistance”. Conference abstracts, dissertation abstracts, and editorial comments were excluded. As a result, 79 of the 158 publications were selected and included in this review. 19 sources were used for the introduction, 60 sources for the main body, and 7 sources, previously mentioned in the main body, for the discussion.

Results

Results. Based on this review, we propose recommendations for additional screening of prostate cancer patients receiving androgen-deprivation therapy and present promising approaches to reducing metabolic disturbances and increasing cancer-specific survival. Thus, glucagon-like peptide-1 receptor agonists and statins can not only correct metabolic disorders but also influence carcinogenesis. RANKL inhibitors also have a dual effect, breaking the vicious cycle of bone resorption in metastases. The positive impact of physical activity and nutritional modification on the quality of life and life expectancy of this patient cohort has been demonstrated. Modifications to androgen deprivation therapy through the use of an intermittent regimen or the use of releasing hormone antagonists can also reduce the risk of metabolic complications.

Conclusions

Conclusions. An integrated approach to monitoring and treatment improves the quality of life and life expectancy of prostate cancer patients receiving androgen deprivation therapy, as well as the outcomes of systemic antitumor therapy.

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The authors declare that there are no conflicts of interest present.