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Prostate cancer (PC) is one of the leading causes of cancer death in the male population. Currently, the pathogenesis of prostate cancer has been studied in sufficient detail, which makes a successful radical treatment possible in most cases. However, in about 30% of patients traditional methods (e.g., radical prostatectomy, radiation therapy, androgen deprivation therapy – ADT, etc.) are ineffective, and castration- resistant (CRPC) and metastatic (mPC) types of РС are developing. Due to the advances in modern molecular oncology, various “workarounds”, genetic and epigenetic combinations, that allow РС to progress despite the absence of androgenic stimulation, are known nowadays. A personalized approach in oncology, which gradually becomes one of the standards for mCRPC therapy, allows not only to identify specific mutations, but also to select the most effective therapy for them in the most correct way. Now the most promising groups of the drugs for mCRPC treatment are poly(ADP-ribose)-polymerase (PARP) inhibitors, immune checkpoint inhibitors, and prostate- specific membrane antigen (PSMA) targeted therapy. This article attempts to summarize the current data on PARP inhibitors. The drugs of this group are especially effective for malignant neoplasms with mutations in the BRCA 1/2 genes, and successfully used in ovarian, breast and pancreatic cancer. They have been approved for the treatment of mCRPC a not so long ago. The advent of personalized companion tests has made the treatment of mCRPC more precise. Nowadays studies on the effectiveness of PARP inhibitors for mCRPC with other genetic and epigenetic changes, as well as in combination with other therapeutic agents, are notably actual.

Bone metastases often develop in patients with prostate cancer (PC) as a natural stage in the course of the disease. The skeletal system is the most typical and sometimes even the only site of metastatic prostate cancer. The involvement of bones is a cause of reduced life expectancy and a strong prognostic factor for adverse events, such as bone complications (including the pain requiring surgery or palliative radiation therapy, pathologic fractures and spinal cord compression), resulting in a significant decrease in the quality of life.The model of therapeutic decision-making in metastatic castration-resistant PC (mCRPC) is still an unsolved problem. Several therapeutic options have been developed recently, that has significantly improved the survival of patients with mCRPC. The presence of multiple active agents provides oncologists with an unprecedented opportunity to tailor their choices to the clinical characteristics of each patient and to each line of treatment, but at the same time it creates the challenge of determining the optimal therapeutic sequence for the individual patient.In Russia, radium-223 is approved for patients having bone metastases and no visceral metastases. It can be assigned to patients with lymph node metastases and patients with bulky bone metastases if other drugs are contraindicated to them. However, the use of radium-223 is most preferable if a patient has bone metastases and good bone marrow reserve.Due to the evolution of treatment strategies, the complexity of the process of assessing the dynamics of treatment and the variability of the clinical aspects of the disease, a multidisciplinary approach becomes of great importance today.

This review is dedicated to the impact of modern achievements on the definition and diagnostics of castration-resistant prostate cancer (PCa) (CRPC), prognostic factors for its progression, and treatment strategies.It was proven with new sensitive methods of diagnostics that surgical castration (CS) decreases serum testosterone (T) levels to < 20 ng/dL, while achieving T < 20 ng/dL improves outcomes and delays the development of CRPC. Regular assessment of the T level makes it possible to understand whether this androgen is adequately suppressed in the setting of potential progression of CRPC, given that late dosing may lead to an increase in T level. Improved imaging techniques and biomarker analysis enable early detection of disease progression. Prognostically significant risk factors for CRPC progression include Gleason score, the extent of metastatic spread, hereditary characteristics such as gene mutations affecting androgen receptor (AR) amplification or DNA repair deficiency mutations, prostate-specific antigen (PSA) kinetics, and biomarker levels. Today, treatment options for CRPC have gone beyond androgen deprivation therapy (ADT) to include therapy that blocks T-synthesis and/or suppresses its activity through various mechanisms. Future directions include therapies using new biological targets, drug combinations and personalized therapies. It is necessary to assess the possible reasons for the difference in the pharmacodynamics and pharmacokinetics of androgendeprivation drugs, to study the features of the processes of destruction of drugs under the action of endogenous enzymes and resorption in the subcutaneous or muscle depot, which may cause the resistance to therapy.The aim of improved treatment and diagnostic options for PCa is to delay its progression to CRPC and to prolong patient survival. Rethinking of the castration concept and advances in understanding the biology of disease progression make it necessary to revise diagnostic and treatment strategies. ADT is a fundamental vector of treatment, and it should be continued even if some new ways of treatment for CRPC are introduced.

Prostate cancer (PC) is one of the major health problems of the male population. The most difficult is the treatment of metastatic castration-resistant prostate cancer (mCRPC), which is the main cause of mortality from PC. In the course of treatment of PC, it inevitably becomes refractory to castration, characterized by the growth of PSA and clinical signs of progression. Octreotidedepo, a representative of the synthetic analogue of somatostatin of prolonged action, has a therapeutic effect in patients with CRPC with a positive total response in the form of a decrease or stabilization of the PSA level, the drug has a favorable safety profile and is easily tolerated by patients. The economic benefit of Octreotide-depo is estimated in the article. Cost-effectiveness analysis has shown its high clinical and economic efficiency. After the establishment of CRPC, first of all, the preparation Oсtreotide-depo will allow to postpone the start of chemotherapy with docetaxel or hormonal therapy of the 2nd line by 7–8 months and save up to 17% of funds in the first year of treatment.

Our surveillance was performed for 358 patients with locally advanced and disseminated prostate gland cancer who were treated by analogues of LHRH. Patients in group 1 (n = 222) received treatment with a LHRH analogue, and patients in group 2 (n = 136) received treatment with 75 mg Buserelin-depo 3. Experience has shown that the use of the Buserelin-Depot drug results in a regression of the average PSA value: Up to 36.05 ng/ml in 2 months, up to 12.35 ng/ml - in four months, up to 3.3 ng/ml - in six months. The drug ensures a steady decrease in the level of testosterone in the blood serum to the castration level already in a month after the start of treatment, a decrease in prostate gland volume (from 57.3 to 40.45 cc 3 by month 6 of treatment (-29.4%)). A number of patients have experienced a decrease in the need for analgesics and thus an increase in the activity status. The obtained data are comparable to those in the group of patients receiving other analogues of LHRH.

In recent years several therapeutic options have been developed that significantly improve the survival of patients with metastatic treatment-resistant prostate gland cancer (mCRPC). The presence of several active agents gives oncologists an unprecedented opportunity to adapt their choices to the clinical characteristics of each patient, to each treatment line, but at the same time raises the problem of determining the optimal therapeutic sequence for the individual. Due to evolution of the therapeutic strategy, difficulty of the process of the therapy dynamics evaluation and variability of the clinical disease aspects the multi-disciplinary approach currently acquires the primary importance. This article presents the views and recommendations of the expert of the Interdisciplinary Group (Milan, Italy) on the use of Radium-223 in men with mCRPC.

Androgen suppression strategy has become the key treatment of advanced prostate cancer. Historically, testosterone level below 1.73 nmol/l (50 ng/dl) was regarded as the castrate level. The current data shows that in an attempt to improve the therapeutic outcome, the new target for chemical castration is testosterone level below 0.69 nmol/l (20 ng/dl). Testosterone surges and suboptimal castrate level due to LHRH analogue therapy result in a porrer control for prostate cancer. Obese men have higher levels of testosterone during treatment with LHRH analogues than patients with a normal body mass index. The study of androgen ablation consists in identifying those agents which would allow to achieve and maintain the lowest possible levels of testosterone.

429 patients with histologically confirmed prostate cancer undergoing various treatment from 1995 till 2014 were studied retrospectively. Overall survival with the baseline PSA less than 30 ng/ml averaged 50.5 months; with higher rates of PSA, the lifespan was reduced to 28 months regardless of treatment. The cause of death of 150 (35%) patients with PSA below 30ng/ml was not an oncological disease. Even with the initial PSA more than 30 ng/ml, 39 patients (9.1%) died from comorbidities. PSA above 30 ng/ml is a poor prognostic factor requiring a more aggressive approach to the treatment of these patients. Gleason score above 7 points is associated with a worse life expectancy forecast as well as a considerable decrease in the quality of life. PSA level determination continues to play a key role in the early detection of prostate cancer.