Russian MedicineRussian MedicineРоссийский медицинский журнал0869-21062412-9100Eco-Vector7226110.17816/0869-2106-2021-27-1-45-55Clinical medicineКлиническая медицинаResearch ArticleStructural model for formation of packages of clinical and diagnostic tests to organize personalized medical care for patients with malignant tumors of the prostate glandСтруктурная модель формирования пакетов клинико-диагностических тестов при организации персонализированной медицинской помощи пациентам со злокачественными опухолями предстательной железыhttps://orcid.org/0000-0003-0745-9474AndreevDmitry A.АндреевДмитрий Анатольевич
Russian Federation

MD, Cand. Sci. (Med.)

ученая степень «doctor», присужденная в Erasmus University Medical Center (г. Роттердам, Нидерланды)

dmitry.email08@gmail.comhttps://orcid.org/0000-0003-1825-1871A-7169-2017ZavyalovAleksander A.ЗавьяловАлександр Александрович
Russian Federation

МD, Dr. Sci. (Med.), Professor

д. м. н., профессор

azav06@mail.ruResearch Institute for Healthcare Organization and Medical Management of Moscow Healthcare DepartmentНаучно-исследовательский институт организации здравоохранения и медицинского менеджмента Департамента здравоохранения города Москвы1502202127145552706202127062021Copyright ©; 2021, Eco-VectorCopyright ©; 2021, ООО "Эко-Вектор"2021Eco-VectorООО "Эко-Вектор"https://medjrf.com/0869-2106/article/view/72261

BACKGROUND: Prostate carcinoma is a serious social and economic problem; it ranks second among the most frequently diagnosed malignant tumors worldwide and it ranks sixth in the structure of causes of death from cancer in men. The correct organization of prevention and screening as well as the use of the latest methods of clinical instrumental and molecular analysis at all stages of treatment and diagnostic process can fundamentally improve the outcomes of the disease.

AIM: This study aimed to analyze of the best international experience in the development of basic clinical and instrumental test packages that determine the personalized choice of medical prescriptions for the treatment and diagnostic process of prostate cancer.

METHODS: The study included papers published after January 1, 2008, with an emphasis on the analysis of results posted in the last 2 years in the PubMed/Medline electronic database as reliable sources of information.

RESULTS AND DISCUSSION: This study explored the basic structural model of the formation of clinical and diagnostic packages at the implementation of a personalized treatment and diagnostic process in prostate cancer. The main biomarkers of prostate cancer used in clinical practice have been identified, and the informative value of the newest biomarker tests has been established. Diagnostic tools that are ready for wider implementation in oncological practice are predictive models, such as the 4K algorithm, Score, SelectMDx, Stockholm-3 model, justifying the need to perform a prostate biopsy in a particular patient. Some promising biomarker characteristics of prostate cancer, assessed at the nonclinical, experimental stage, have been demonstrated.

CONCLUSIONS: This study found that (1) Revision of the algorithms for personalized treatment is becoming an important element in the provision of patient-oriented cancer care. (2) Periodic reassessment of the “individual portrait” of the tumor process is necessary for the correct organization of treatment and diagnostic measures in a particular patient. (3) Finally, for the implementation of the whole range of possibilities of individual treatment, close interaction with the representatives of various medical specialties in the framework of the implementation of translational medicine programs in oncologyis important.

Актуальность. Рак предстательной железы представляет собой серьезную социально-экономическую проблему, занимает второе место среди наиболее часто диагностируемых злокачественных опухолей в мире и шестую позицию в структуре причин смерти от рака у мужчин. Правильная организация профилактики и скрининга, а также использование новейших методов клинико-инструментального и молекулярного анализа на всех этапах лечебно-диагностического процесса позволяют принципиально улучшить исходы заболевания у пациентов.

Цель. Анализ передового зарубежного опыта по формированию пакетов основных клинико-инструментальных тестов, определяющих персонализированный выбор медицинских назначений на этапах лечебно-диагностического процесса при раке предстательной железы.

Методы. В исследование включали работы, опубликованные в период после 1 января 2008 года с акцентом на анализ результатов, размещенных в последние два года в электронной базе PubMed/Medline, в качестве надежных источников информации.

Результаты и обсуждение. Изучена базовая структурная модель формирования клинико-диагностических пакетов на этапах реализации персонализированного лечебно-диагностического процесса при раке предстательной железы. Идентифицированы основные биомаркеры рака предстательной железы, используемые в клинической практике. Установлена информативность наиболее новых биомаркерных тестов. Приведены примеры диагностических инструментов, готовых к более широкому внедрению в онкологическую практику, — предиктивные модели (алгоритм 4K, Score, SelectMDx, Stockholm-3 model и т. д.), обосновывающие необходимость выполнения биопсии предстательной железы у конкретного пациента. Продемонстрированы некоторые перспективные биомаркерные характеристики рака предстательной железы, изучаемые на доклиническом, экспериментальном этапе.

Выводы. 1. Пересмотр алгоритмов персонализированного лечения становится важным элементом оказания пациент-ориентированной онкологической помощи. 2. Периодическая переоценка «индивидуального портрета» опухолевого процесса необходима для правильной организации лечебно-диагностических мероприятий у конкретного больного. 3. Для реализации всего комплекса возможностей индивидуального лечения важно тесное взаимодействие между представителями различных медицинских специальностей в рамках реализации программ трансляционной медицины в онкологии.

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