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should involve the patients in decision making process Despite the fact that what a prostate cancer widespread
disease its treatment remains inconsistent The majority of patients with a cancer of a prostate is more senior
65 years middle age of an establishment of the diagnosis 71 year for white Americans and 69 years for Afro
Americans 1 Approximately the prostate cancer but as for this disease the long natural current is
characteristic has been diagnosed for 220 000 American men in 2003 28 900 patients 2 have died the same
year only Conservative treatment or observation was offered alternatively to more aggressive methods of
treatment such as a radical prostatectomy as many of the patients suffering a prostate cancer die of other
reasons in most cases from heart diseases 3 Conservative conducting also can be the suitable decision for
patients more advanced age whose expected life expectancy does not exceed 10 years they hardly will
sustain aggressive treatment or will win from it Recent researches 4 7 have forced to assume that patients
with clinically localised cancer of a prostate live in a condition of remission after a radical prostatectomy or
an irradiation more longly Direct comparison of interventions and observant tactics usually shows that
treatment is more effective Partly it speaks features of structure of the researches devoted to a cancer of a
prostate the regular errors shifts bound to early revealing of disease its long current and selection of patients
about these regular errors in present article clinical outcomes and the remote by effects of the primary
interventions applied at clinically localised cancer of a prostate are discussed including an external remote
irradiation and intersticial implantation of isotopes брахитерапию regular results of screening influence two
powerful factors causing a regular error leading to revaluation of efficiency of screening shift from early
revealing lead time bias and shift from revealing of slowly developing cases length time bias The first arises
because illness revealing in earlier stage naturally leads to augmentation of the period from revealing to
mors but only so the period of a healthy life to a diagnosis establishment was how much reduced Analysis
use on an antigen DOG enlarges a share of clinically localised stage T1 and T2 illnesses among all taped
cases It leads to augmentation of time of a life after a diagnosis establishment for 3 5 years 9 How much the
survival is actually enlarged at screening application by the DOG still it is necessary to learn from proceeding
test 10 from all patients of a tumour develop with different rate in case of slow advance there are more than
chances to tap it at screening For example the most part of the tumours taped at screening with definition of
level of the DOG has average in comparison with the cases taped on clinical implications Among the last more
than low grade tumours Obscurely whether all patients with a tumour of stage Gleason 5 6 profit from
aggressive treatment 13 This regular error also can explain the best results of treatment during the period
after screening introduction on the DOG the survival augmentation is not obligatory to eat a consequence of
earlier revealing and treatment In обсервационных researches of the most important the regular error owing
to selection of patients selection bias is It arises because published results concern not a random sample of
patients and to what observed for example in university surgical clinic It is known that in such clinics there
are complications on urinary ways 14 less often The researches spent in surgical clinics join patients whom
have executed a radical prostatectomy is more often and accordingly at whom operation performance have
refused 15 less often get Patients of surgeons have data of morphological research 4 5 is more often As a
result patients with the localised tumour by results of a radical prostatectomy have outcomes better than
patients with the localised tumour to clinical signs The patients receiving conservative treatment and an
irradiation patients with metastasises are excluded from a cohort of the observed МетодыДля estimations of
results of treatment have been executed the regular review of the literature published for last 15 years
Search terms the cancer of a prostate and a prostatectomy irradiation or expectant tactics and included a
cancer простаты amp качество lives or complications at treatment Headings and abstracts looked through
selecting articles in which described results of treatment or complication after treatment Articles hormonal
combined or органосохраняющую therapy have not been included Methods from interventions at a prostate
cancer conservative conducting at patients with clinical symptoms of disease sometimes in addition apply
androgen ablatsiju 3 In one research 16 based on data of the Konnektikutsky tumoral register studied clinical
outcomes of conservative conducting at 451 patients at the age of 65 75 years with clinically localised cancer
of a prostate the given 1971 1976 In comparison with other group of men of the same age without a prostate
cancer at patients with well differentiated cancer of a prostate 2 4 on scale Gleason have not noted
augmentation of risk of mors At patients with a low grade tumour 8 10 on scale Gleason the risk of mors
increased in 2 3 times Recently carried out analysis of data about 12 of 767 patients from this the register
has shown that patients with the tumours estimated on scale Gleason from 2 to 4 and from 5 to 6 at
conservative conducting had concerning small risk of mors from a prostate cancer patients with indicator
Gleason from 7 дo 10 at conservative conducting however had more chances to die of a prostate cancer than
for other reasons tab 1 12 ПростатэктомияХирургическое prostate excision the intervention applied at
patients with clinically localised cancer Big рандомизированное controllable test РКИ begun already after
introduction in wide practice of screening with use of the DOG comparing a radical prostatectomy and
conservative treatment will not be finished some more years 10 Results of the Scandinavian research 7 in
which 695 patients with clinically localised cancer of a prostate middle age 65 5 years рандомизировали in
groups of a radical prostatectomy or conservative treatment average time of observation 6 2 years are
recently published The majority of patients had an indicator on scale Gleason 5 6 More than at 1 3 patients
the diagnosis has been established on set of symptoms only at 5 as a result of the DOG SCREENING On 8th
year at 14 of the patients receiving conservative treatment of 95 a confidential interval Dee from 7 to 15 and
at 7 of patients by which the prostatectomy has been executed 95 of Dee from 3 to 11 have developed
metastasises The relative risk of mors from a prostate cancer in group of a radical prostatectomy in
comparison with group of conservative treatment corrected on age indicators Gleason and a cancer stage has
made 0 45 95 of Dee from 0 25 to 0 84 17 However the difference in the general survival rate between two
groups was statistically незначима It is important to notice that research could be insufficiently powerful for
revealing of such difference Besides still it is necessary to define whether improvement of survival rate after a
radical prostatectomy for the remote period extends Some researches of series of cases force to assume that
patients with an early cancer of a prostate have the best безрецидивную survival rate in the remote period
after a radical prostatectomy In clinic of Mayo investigated 2518 patients with a prostate cancer middle age
63 years which have executed a radical prostatectomy in 1990 1993 the average period of observation 5 6
years The majority of patients had an estimation 5 6 on scale Gleason Less than at 20 the diagnosis has been
established as a result of the DOG SCREENING 5 year old безрецидивная the survival rate at patients with
clinically localised cancer of a prostate T1 and T2 has made 73 83 at patients with a stage of cancer T3 63 4
В other big series of researches 5 2091 patient middle age 58 1 6 6 year with clinically localised cancer of a
prostate participated To all of them the radical prostatectomy in 1982 1999 the Majority of patients has been
executed had an estimation 5 6 on scale Gleason at 40 of patients the diagnosis has been established as a
result of the DOG SCREENING Level of the DOG above 0 2 ng ml regarded as a relapse indicator 5 10 and 15
year old survival rate without biochemical relapse there were 84 72 and 63 accordingly 5 10 and 15 year old
survival rate without metastasises 96 89 and 81 5 One more research 18 has shown that average time before
occurrence of biochemical relapse makes 8 years and average time of formation of metastasises after
biochemical relapse 10 years These researches show high безрецидивную survival rate of patients with
clinically localised cancer after a radical prostatectomy However to do any conclusions about efficiency of a
surgical intervention these results should be compared to earlier researches studying remote results of
conservative treatment during the period before introduction in wide practice of the DOG SCREENING This
comparison can contain a regular error in favour of a surgical intervention as at some patients subjected to a
surgical intervention in later researches the diagnosis has been established as a result of the DOG
SCREENING Thus in later researches included more patients with the localised disease shift from early
revealing Also remains not clear whether the same type of a cancer is found out at an early stage by the DOG
SCREENING as at diagnostics on the basis of an estimation of clinical symptoms shift from revealing of slowly
developing cases And at last these surgical researches have included only the patients transferred a radical
prostatectomy and observed in the medical centres of the third step the specialised clinics equipped with
equipment of the higher class and their results can appear are intolerable on all sick of a prostate cancer shift
owing to selection of patients Therefore results of observations over patients during an era of the DOG
SCREENING united in the big databases for example Surveillance Epidemiology and End Results are more
applicable to the average patient 8 However these databases only start to be formed because of a long natural
current of a cancer of a prostate and time necessary for updating of these databases 19 ОблучениеДругое
intervention applied at patients with the localised cancer of a prostate an external or intersticial irradiation
the tele irradiation has replaced a traditional external irradiation as allows to refer on a prostate the big doses
of radiation simultaneously subjecting to smaller influence surrounding tissues 20 The intersticial irradiation
or брахитерапия includes a premise of radioactive granules for example iodine 125 or a palladium 103 in a
prostate tissue The large researches comparing irradiations with other interventions to the period after
introduction of the DOG SCREENING it was not spent Some clinical outcomes which are not characteristic only f
or a cancer of a prostate such as the general survival rate can be worse after an irradiation as the patients
subjected to an irradiation usually are more senior and have more than accompanying diseases in comparison
with the patients subjected to a radical prostatectomy shift owing to selection of patients For comparison of
results of treatment it is preferable to choose the researches including patients with similar clinical stages and
classification of a tumour for minimisation of regular errors Recent retrospective group research 21 has taped
similar frequency biochemical рецидивирования after a radical prostatectomy and the big exposure dose 72
Гр The difference between an irradiation and a radical prostatectomy can be bound to carrying out of the
DOG SCREENING and a tumour T stage early revealing and with an estimation on scale Gleason at a biopsy
revealing of slowly developing forms 21 Some other researches of series of cases also have shown that
survival rate after an irradiation and after a radical prostatectomy are similar 6 7 Efficiency брахитерапии
and an external irradiation also are similar 22 23 После radial therapy as a whole has less risk of occurrence
of disorder of an erection and more risk of chronic diseases of an intestine in comparison with a radical
prostatectomy Remote collateral эффектыПри a radical prostatectomy the risk of immediate serious
complications including risk of mors 24 is highest Despite the fact that what all interventions possess the
remote by effects patients with larger probability test symptoms of advance of disease urinary obstruction an
ostealgia during conservative treatment 25 As at conservative treatment metastasises develop in 2 times
more often these patients with larger probability will require hormonal therapy which causes by effects such
as weariness and inflow 17 26 Нарушение erections and the by effects concerning urinary ways the most
frequent remote by effects of a radical prostatectomy and an irradiation tab 2 The risk of development of
these symptoms is enlarged with the years the patient and in the presence of accompanying diseases 48 49
Smaller frequency of occurrence of complications is characteristic for hospitals in which many prostatectomies
14 are carried out Erectile dysfunction arises less often after one or a bilateral prostatectomy with conservation
of a nervous plexus 42 50 By effects from urinary system arise after operations c conservation of a neck of a
bladder 51 and muscles of distal department of a sphincter of an urethra 49 less often The estimation of risk
of complications also depends on how by effects described in research frequency of complications tends to
rising if symptoms are described by patients instead of the doctor 2 43 Более than at 50 of patients it is
possible to expect occurrence of erectile dysfunction as a result of a radical prostatectomy 27 28 37 38 After
the risk of this complication is less than irradiation 35 Risk of a true uracrasia low but urine an
everyday occurrence after a radical prostatectomy and a tele irradiation 27 32 49 Irritating symptoms from
urinary system become perceptible after брахитерапии than after a tele irradiation 35 is more often The risk
of the remote symptoms of a lesion of an intestine тенезмы подтекание a feces is highest after a tele
irradiation 27 29 The risk of the remote symptoms of a lesion of an intestine after брахитерапии is low 36 52
О Обсервационные researches speak about good безрецидивной to survival rate after a radical
prostatectomy or radial therapy in case of clinically localised Prostate cancer For patients tab 3 Before end
aforementioned РКИ it is difficult enough to reference to recommend with the big confidence the best method
of treatment for the localised cancer of a prostate 10 In connection with the remote by effects very important
it is represented to estimate not only survival rate but also quality of a life of patients In one of new
researches 13 used model of decision making for an estimation of qualitatively spent years of a life QALYs
at patients with the localised cancer of a prostate At patients with an estimation 2 4 on scale Gleason after
treatment the estimation on QALYs decreases on the contrary at patients c by an estimation 7 10 on Gleason
is enlarged Results for patients with an estimation 5 6 are less clear proceeding from the basic assumptions
of the given model the success of treatment should be insignificant The given review concentrates on
methods of treatment of the localised cancer of a prostate Patients with a widespread tumour for example
with экстракапсулярным growth or involving регионарных lymphonoduses are not candidates for treatment
Being based on data of the modern literature following offers can be made to patients with the localised
cancer of a prostate Conservative conducting is shown patients with an estimation 2 4 on scale Gleason as at
the given group of patients life expectancy reduction is not expected and treatment is bound to numerous by
effects On the contrary patients with an estimation 7 10 should consider seriously necessity of treatment a
radical prostatectomy or an irradiation In this group of patients the risk of mors from a cancer of a prostate is
high and after treatment the probability безрецидивного survivals is enlarged The majority of patients have
5 6th degree of a differentiation on scale Gleason As there are no convincing proofs pro or contra treatments
younger patients capable to sustain by effects should agree on a radical prostatectomy or a gamma therapy
13 However more elderly patients or patients with expected life expectancy less than 10 years with average
degree of a differentiation of a tumour probably will not win from application of aggressive methods of
treatment
disease its treatment remains inconsistent The majority of patients with a cancer of a prostate is more senior
65 years middle age of an establishment of the diagnosis 71 year for white Americans and 69 years for Afro
Americans 1 Approximately the prostate cancer but as for this disease the long natural current is
characteristic has been diagnosed for 220 000 American men in 2003 28 900 patients 2 have died the same
year only Conservative treatment or observation was offered alternatively to more aggressive methods of
treatment such as a radical prostatectomy as many of the patients suffering a prostate cancer die of other
reasons in most cases from heart diseases 3 Conservative conducting also can be the suitable decision for
patients more advanced age whose expected life expectancy does not exceed 10 years they hardly will
sustain aggressive treatment or will win from it Recent researches 4 7 have forced to assume that patients
with clinically localised cancer of a prostate live in a condition of remission after a radical prostatectomy or
an irradiation more longly Direct comparison of interventions and observant tactics usually shows that
treatment is more effective Partly it speaks features of structure of the researches devoted to a cancer of a
prostate the regular errors shifts bound to early revealing of disease its long current and selection of patients
about these regular errors in present article clinical outcomes and the remote by effects of the primary
interventions applied at clinically localised cancer of a prostate are discussed including an external remote
irradiation and intersticial implantation of isotopes брахитерапию regular results of screening influence two
powerful factors causing a regular error leading to revaluation of efficiency of screening shift from early
revealing lead time bias and shift from revealing of slowly developing cases length time bias The first arises
because illness revealing in earlier stage naturally leads to augmentation of the period from revealing to
mors but only so the period of a healthy life to a diagnosis establishment was how much reduced Analysis
use on an antigen DOG enlarges a share of clinically localised stage T1 and T2 illnesses among all taped
cases It leads to augmentation of time of a life after a diagnosis establishment for 3 5 years 9 How much the
survival is actually enlarged at screening application by the DOG still it is necessary to learn from proceeding
test 10 from all patients of a tumour develop with different rate in case of slow advance there are more than
chances to tap it at screening For example the most part of the tumours taped at screening with definition of
level of the DOG has average in comparison with the cases taped on clinical implications Among the last more
than low grade tumours Obscurely whether all patients with a tumour of stage Gleason 5 6 profit from
aggressive treatment 13 This regular error also can explain the best results of treatment during the period
after screening introduction on the DOG the survival augmentation is not obligatory to eat a consequence of
earlier revealing and treatment In обсервационных researches of the most important the regular error owing
to selection of patients selection bias is It arises because published results concern not a random sample of
patients and to what observed for example in university surgical clinic It is known that in such clinics there
are complications on urinary ways 14 less often The researches spent in surgical clinics join patients whom
have executed a radical prostatectomy is more often and accordingly at whom operation performance have
refused 15 less often get Patients of surgeons have data of morphological research 4 5 is more often As a
result patients with the localised tumour by results of a radical prostatectomy have outcomes better than
patients with the localised tumour to clinical signs The patients receiving conservative treatment and an
irradiation patients with metastasises are excluded from a cohort of the observed МетодыДля estimations of
results of treatment have been executed the regular review of the literature published for last 15 years
Search terms the cancer of a prostate and a prostatectomy irradiation or expectant tactics and included a
cancer простаты amp качество lives or complications at treatment Headings and abstracts looked through
selecting articles in which described results of treatment or complication after treatment Articles hormonal
combined or органосохраняющую therapy have not been included Methods from interventions at a prostate
cancer conservative conducting at patients with clinical symptoms of disease sometimes in addition apply
androgen ablatsiju 3 In one research 16 based on data of the Konnektikutsky tumoral register studied clinical
outcomes of conservative conducting at 451 patients at the age of 65 75 years with clinically localised cancer
of a prostate the given 1971 1976 In comparison with other group of men of the same age without a prostate
cancer at patients with well differentiated cancer of a prostate 2 4 on scale Gleason have not noted
augmentation of risk of mors At patients with a low grade tumour 8 10 on scale Gleason the risk of mors
increased in 2 3 times Recently carried out analysis of data about 12 of 767 patients from this the register
has shown that patients with the tumours estimated on scale Gleason from 2 to 4 and from 5 to 6 at
conservative conducting had concerning small risk of mors from a prostate cancer patients with indicator
Gleason from 7 дo 10 at conservative conducting however had more chances to die of a prostate cancer than
for other reasons tab 1 12 ПростатэктомияХирургическое prostate excision the intervention applied at
patients with clinically localised cancer Big рандомизированное controllable test РКИ begun already after
introduction in wide practice of screening with use of the DOG comparing a radical prostatectomy and
conservative treatment will not be finished some more years 10 Results of the Scandinavian research 7 in
which 695 patients with clinically localised cancer of a prostate middle age 65 5 years рандомизировали in
groups of a radical prostatectomy or conservative treatment average time of observation 6 2 years are
recently published The majority of patients had an indicator on scale Gleason 5 6 More than at 1 3 patients
the diagnosis has been established on set of symptoms only at 5 as a result of the DOG SCREENING On 8th
year at 14 of the patients receiving conservative treatment of 95 a confidential interval Dee from 7 to 15 and
at 7 of patients by which the prostatectomy has been executed 95 of Dee from 3 to 11 have developed
metastasises The relative risk of mors from a prostate cancer in group of a radical prostatectomy in
comparison with group of conservative treatment corrected on age indicators Gleason and a cancer stage has
made 0 45 95 of Dee from 0 25 to 0 84 17 However the difference in the general survival rate between two
groups was statistically незначима It is important to notice that research could be insufficiently powerful for
revealing of such difference Besides still it is necessary to define whether improvement of survival rate after a
radical prostatectomy for the remote period extends Some researches of series of cases force to assume that
patients with an early cancer of a prostate have the best безрецидивную survival rate in the remote period
after a radical prostatectomy In clinic of Mayo investigated 2518 patients with a prostate cancer middle age
63 years which have executed a radical prostatectomy in 1990 1993 the average period of observation 5 6
years The majority of patients had an estimation 5 6 on scale Gleason Less than at 20 the diagnosis has been
established as a result of the DOG SCREENING 5 year old безрецидивная the survival rate at patients with
clinically localised cancer of a prostate T1 and T2 has made 73 83 at patients with a stage of cancer T3 63 4
В other big series of researches 5 2091 patient middle age 58 1 6 6 year with clinically localised cancer of a
prostate participated To all of them the radical prostatectomy in 1982 1999 the Majority of patients has been
executed had an estimation 5 6 on scale Gleason at 40 of patients the diagnosis has been established as a
result of the DOG SCREENING Level of the DOG above 0 2 ng ml regarded as a relapse indicator 5 10 and 15
year old survival rate without biochemical relapse there were 84 72 and 63 accordingly 5 10 and 15 year old
survival rate without metastasises 96 89 and 81 5 One more research 18 has shown that average time before
occurrence of biochemical relapse makes 8 years and average time of formation of metastasises after
biochemical relapse 10 years These researches show high безрецидивную survival rate of patients with
clinically localised cancer after a radical prostatectomy However to do any conclusions about efficiency of a
surgical intervention these results should be compared to earlier researches studying remote results of
conservative treatment during the period before introduction in wide practice of the DOG SCREENING This
comparison can contain a regular error in favour of a surgical intervention as at some patients subjected to a
surgical intervention in later researches the diagnosis has been established as a result of the DOG
SCREENING Thus in later researches included more patients with the localised disease shift from early
revealing Also remains not clear whether the same type of a cancer is found out at an early stage by the DOG
SCREENING as at diagnostics on the basis of an estimation of clinical symptoms shift from revealing of slowly
developing cases And at last these surgical researches have included only the patients transferred a radical
prostatectomy and observed in the medical centres of the third step the specialised clinics equipped with
equipment of the higher class and their results can appear are intolerable on all sick of a prostate cancer shift
owing to selection of patients Therefore results of observations over patients during an era of the DOG
SCREENING united in the big databases for example Surveillance Epidemiology and End Results are more
applicable to the average patient 8 However these databases only start to be formed because of a long natural
current of a cancer of a prostate and time necessary for updating of these databases 19 ОблучениеДругое
intervention applied at patients with the localised cancer of a prostate an external or intersticial irradiation
the tele irradiation has replaced a traditional external irradiation as allows to refer on a prostate the big doses
of radiation simultaneously subjecting to smaller influence surrounding tissues 20 The intersticial irradiation
or брахитерапия includes a premise of radioactive granules for example iodine 125 or a palladium 103 in a
prostate tissue The large researches comparing irradiations with other interventions to the period after
introduction of the DOG SCREENING it was not spent Some clinical outcomes which are not characteristic only f
or a cancer of a prostate such as the general survival rate can be worse after an irradiation as the patients
subjected to an irradiation usually are more senior and have more than accompanying diseases in comparison
with the patients subjected to a radical prostatectomy shift owing to selection of patients For comparison of
results of treatment it is preferable to choose the researches including patients with similar clinical stages and
classification of a tumour for minimisation of regular errors Recent retrospective group research 21 has taped
similar frequency biochemical рецидивирования after a radical prostatectomy and the big exposure dose 72
Гр The difference between an irradiation and a radical prostatectomy can be bound to carrying out of the
DOG SCREENING and a tumour T stage early revealing and with an estimation on scale Gleason at a biopsy
revealing of slowly developing forms 21 Some other researches of series of cases also have shown that
survival rate after an irradiation and after a radical prostatectomy are similar 6 7 Efficiency брахитерапии
and an external irradiation also are similar 22 23 После radial therapy as a whole has less risk of occurrence
of disorder of an erection and more risk of chronic diseases of an intestine in comparison with a radical
prostatectomy Remote collateral эффектыПри a radical prostatectomy the risk of immediate serious
complications including risk of mors 24 is highest Despite the fact that what all interventions possess the
remote by effects patients with larger probability test symptoms of advance of disease urinary obstruction an
ostealgia during conservative treatment 25 As at conservative treatment metastasises develop in 2 times
more often these patients with larger probability will require hormonal therapy which causes by effects such
as weariness and inflow 17 26 Нарушение erections and the by effects concerning urinary ways the most
frequent remote by effects of a radical prostatectomy and an irradiation tab 2 The risk of development of
these symptoms is enlarged with the years the patient and in the presence of accompanying diseases 48 49
Smaller frequency of occurrence of complications is characteristic for hospitals in which many prostatectomies
14 are carried out Erectile dysfunction arises less often after one or a bilateral prostatectomy with conservation
of a nervous plexus 42 50 By effects from urinary system arise after operations c conservation of a neck of a
bladder 51 and muscles of distal department of a sphincter of an urethra 49 less often The estimation of risk
of complications also depends on how by effects described in research frequency of complications tends to
rising if symptoms are described by patients instead of the doctor 2 43 Более than at 50 of patients it is
possible to expect occurrence of erectile dysfunction as a result of a radical prostatectomy 27 28 37 38 After
the risk of this complication is less than irradiation 35 Risk of a true uracrasia low but urine an
everyday occurrence after a radical prostatectomy and a tele irradiation 27 32 49 Irritating symptoms from
urinary system become perceptible after брахитерапии than after a tele irradiation 35 is more often The risk
of the remote symptoms of a lesion of an intestine тенезмы подтекание a feces is highest after a tele
irradiation 27 29 The risk of the remote symptoms of a lesion of an intestine after брахитерапии is low 36 52
О Обсервационные researches speak about good безрецидивной to survival rate after a radical
prostatectomy or radial therapy in case of clinically localised Prostate cancer For patients tab 3 Before end
aforementioned РКИ it is difficult enough to reference to recommend with the big confidence the best method
of treatment for the localised cancer of a prostate 10 In connection with the remote by effects very important
it is represented to estimate not only survival rate but also quality of a life of patients In one of new
researches 13 used model of decision making for an estimation of qualitatively spent years of a life QALYs
at patients with the localised cancer of a prostate At patients with an estimation 2 4 on scale Gleason after
treatment the estimation on QALYs decreases on the contrary at patients c by an estimation 7 10 on Gleason
is enlarged Results for patients with an estimation 5 6 are less clear proceeding from the basic assumptions
of the given model the success of treatment should be insignificant The given review concentrates on
methods of treatment of the localised cancer of a prostate Patients with a widespread tumour for example
with экстракапсулярным growth or involving регионарных lymphonoduses are not candidates for treatment
Being based on data of the modern literature following offers can be made to patients with the localised
cancer of a prostate Conservative conducting is shown patients with an estimation 2 4 on scale Gleason as at
the given group of patients life expectancy reduction is not expected and treatment is bound to numerous by
effects On the contrary patients with an estimation 7 10 should consider seriously necessity of treatment a
radical prostatectomy or an irradiation In this group of patients the risk of mors from a cancer of a prostate is
high and after treatment the probability безрецидивного survivals is enlarged The majority of patients have
5 6th degree of a differentiation on scale Gleason As there are no convincing proofs pro or contra treatments
younger patients capable to sustain by effects should agree on a radical prostatectomy or a gamma therapy
13 However more elderly patients or patients with expected life expectancy less than 10 years with average
degree of a differentiation of a tumour probably will not win from application of aggressive methods of
treatment
Interventions at a prostate cancer: an estimation of proofs
Conservative conducting the localised cancer of a prostate prostatectomy
and radial therapy very different methods The choice between them is
combined because of long term by effects which can concern genitourinary
system or cause intestine dysfunction Recently carried out researches
show that the patients who have chosen treatment i e a radical
prostatectomy or an irradiation live after treatment in comparison with
the patients who have chosen conservative observation more longly
However various regular errors shift can is artificial to raise efficiency of
treatment and by that to make interpreting of research of results of
treatment difficult Sources of a regular error shift include early revealing
of disease revealing of slowly developing cases and selection of patients
In the absence of convincing data concerning efficiency of methods of
treatment and existence of risk of long term complications family doctors
and radial therapy very different methods The choice between them is
combined because of long term by effects which can concern genitourinary
system or cause intestine dysfunction Recently carried out researches
show that the patients who have chosen treatment i e a radical
prostatectomy or an irradiation live after treatment in comparison with
the patients who have chosen conservative observation more longly
However various regular errors shift can is artificial to raise efficiency of
treatment and by that to make interpreting of research of results of
treatment difficult Sources of a regular error shift include early revealing
of disease revealing of slowly developing cases and selection of patients
In the absence of convincing data concerning efficiency of methods of
treatment and existence of risk of long term complications family doctors