The 23 references with contexts in paper M. RYBALOV A., I. De YONG Ya, A. BREUSMA J., S. AL-SHUKRI H., S. BOROVETS Yu., М. РЫБАЛОВ А., И. ДЕ ЙОНГ Я., А. БРЕУСМА Й., С. АЛЬ-ШУКРИ Х., С. БОРОВЕЦ Ю. (2011) “РОЛЬ ПРОСТАТОСПЕЦИФИЧЕСКОГО АНТИГЕНА И ЕГО КИНЕТИЧЕСКИХ ХАРАКТЕРИСТИК ПРИ ОТБОРЕ БОЛЬНЫХ ДЛЯ КОНТРОЛЬНОЙ 11C-ХОЛИН ПОЗИТРОННО-ЭМИССИОННОЙ/ КОМПЬЮТЕРНОЙ ТОМОГРАФИИ ПОСЛЕ РАДИОТЕРАПИИ ИЛИ РАДИКАЛЬНОЙ ПРОСТАТЭКТОМИИ // ROLE OF PROSTATE SPECIFIC ANTIGEN AND ITS KINETIC CHARACTERISTICS AT PАTIENT SELECTION FOR CONTROL 11C-CHOLIN POSITRON-EMISSION/COMPUTERIZED TOMOGRAPHY AFTER RADIOTHERAPY AND RADICAL PROSTATECTOMY” / spz:neicon:nefr:y:2011:i:4:p:55-61

1
Han M, Partin AW, Pound CR, Epstein JI, Walsh PC. Longterm biochemical disease-free and cancer-specific survival following anatomic radical retropubic prostatectomy. The 15year Johns Hopkins experience. Urol Clin North Am 2001; 28: 555–565
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    ВВЕДЕНИЕ Îáùåïðèíÿòûìè ìåòîäàìè òåðàïèè áîëüíûõ ñ äèàãíîñòèðîâàííûì ëîêàëèçîâàííûì ðàêîì ïðåäñòàòåëüíîé æåëåçû (ÐÏÆ) ÿâëÿþòñÿ ðàäèêàëüíàÿ ïðîñòàòýêòîìèÿ (ÐÏ) è ðàäèîòåðàïèÿ (ÐÒ). Îäíàêî ó 15–46% ïàöèåíòîâ, ïåðåíåñøèõ ÐÏ, ïîçäíåå âûÿâëÿåòñÿ ïîâûøåíèå óðîâíÿ ÏÑÀ
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    , ÷òî ÿâëÿåòñÿ ñàìûì ðàííèì ïðèçíàêîì ðåöèäèâà ÐÏÆ. Ó 80% ìóæ÷èí, êîòîðûì ïðîâîäèëàñü ÐÒ ïî ïîâîäó ëîêàëèçîâàííîãî ÐÏÆ, îòìå÷àåòñÿ ïîâûøåíèå óðîâíÿ ÏÑÀ â ñðåäíåì â òå÷åíèå 5 ëåò íàáëþäåíèÿ [2]. Íåñìîòðÿ íà òî, ÷òî îïðåäåëåíèå óðîâíÿ ÏÑÀ â ïëàçìå êðîâè ÿâëÿåòñÿ íàèáîëåå ÷óâñòâèòåëüíûì ìåòîäîì äëÿ îáíàðóæåíèÿ ðåöèäèâà ÐÏÆ, ìåòîä íå ïîçâîëÿåò äèôôåðåíöèðîâàòü ìåñòíûé ðåöèäèâ ÐÏÆ îò íàëè÷èÿ îòäàë ̧ííû

2
Zagars GK. Prostate specific antigen as an outcome variable for T1 and T2 prostate cancer treated by radiation therapy. J Urol 1994; 152: 1786-1791
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    Îäíàêî ó 15–46% ïàöèåíòîâ, ïåðåíåñøèõ ÐÏ, ïîçäíåå âûÿâëÿåòñÿ ïîâûøåíèå óðîâíÿ ÏÑÀ [1], ÷òî ÿâëÿåòñÿ ñàìûì ðàííèì ïðèçíàêîì ðåöèäèâà ÐÏÆ. Ó 80% ìóæ÷èí, êîòîðûì ïðîâîäèëàñü ÐÒ ïî ïîâîäó ëîêàëèçîâàííîãî ÐÏÆ, îòìå÷àåòñÿ ïîâûøåíèå óðîâíÿ ÏÑÀ â ñðåäíåì â òå÷åíèå 5 ëåò íàáëþäåíèÿ
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    . Íåñìîòðÿ íà òî, ÷òî îïðåäåëåíèå óðîâíÿ ÏÑÀ â ïëàçìå êðîâè ÿâëÿåòñÿ íàèáîëåå ÷óâñòâèòåëüíûì ìåòîäîì äëÿ îáíàðóæåíèÿ ðåöèäèâà ÐÏÆ, ìåòîä íå ïîçâîëÿåò äèôôåðåíöèðîâàòü ìåñòíûé ðåöèäèâ ÐÏÆ îò íàëè÷èÿ îòäàë ̧ííûõ ìåòàñòàçîâ [3].

3
Breeuwsma AJ, Pruim J, Van Den Bergh ACM et al. Detection of local, regional and distant recurrence in patients with PSA relapse after external beam radiotherapy using 11Ccholine positron emission tomography. Int J Radiat Oncol Biol Phys 2010; 77: 160-164
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    Íåñìîòðÿ íà òî, ÷òî îïðåäåëåíèå óðîâíÿ ÏÑÀ â ïëàçìå êðîâè ÿâëÿåòñÿ íàèáîëåå ÷óâñòâèòåëüíûì ìåòîäîì äëÿ îáíàðóæåíèÿ ðåöèäèâà ÐÏÆ, ìåòîä íå ïîçâîëÿåò äèôôåðåíöèðîâàòü ìåñòíûé ðåöèäèâ ÐÏÆ îò íàëè÷èÿ îòäàë ̧ííûõ ìåòàñòàçîâ
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    . Ñ öåëüþ ðåøåíèÿ ýòîé ïðîáëåìû â ïîñëåäíèå ãîäû ñòàëè àêòèâíî èçó÷àòü êèíåòè÷åñêèå õàðàêòåðèñòèêè ÏÑÀ (ñêîðîñòü íàðàñòàíèÿ è âðåìÿ óäâîåíèÿ ÏÑÀ), îïðåäåëåíèå êîòîðûõ ïî ðåçóëüòàòàì ïîñëåäíèõ èññëåäîâàíèé ïîçâîëÿåò äèàãíîñòèðîâàòü âîçíèêíîâåíèå ðåöèäèâîâ è ïðîãíîçèðîâàòü âûæèâàåìîñòü áîëüíûõ ïðè ÐÏÆ [4–8].

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    Ðàñ÷åò âðåìåíè óäâîåíèÿ ÏÑÀ öåëåñîîáðàçåí äëÿ âûÿâëåíèÿ áîëüíûõ ñ ÐÏÆ ñ âûñîêèì ðèñêîì ñìåðòè îò äàííîãî çàáîëåâàíèÿ, ÷òî ñïîñîáñòâóåò îïòèìèçàöèè ëå÷åíèÿ òàêèõ ïàöèåíòîâ [9]. 11C-õîëèí ïîçèòðîííî-ýìèññèîííàÿ òîìîãðàôèÿ (ÏÝÒ) ïîçâîëÿåò ñ âûñîêîé òî÷íîñòüþ âûÿâëÿòü ðåöèäèâû ÐÏÆ ó ïàöèåíòîâ ïîñëå ÐÒ, íî åå äèàãíîñòè÷åñêèå âîçìîæíîñòè õóæå ïðè îáñëåäîâàíèè ïàöèåíòîâ, ïåðåíåñøèõ ÐÏ
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    [3,10–13]
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    . Êîìáèíèðîâàííàÿ ÏÝÒ/ÊÒ ïîâûøàåò ýôôåêòèâíîñòü äèàãíîñòèêè, îñîáåííî â ñî÷åòàíèè ñ ðåçóëüòàòàìè, ïîëó÷åííûìè ïðè ìîðôîëîãè÷åñêîì èññëåäîâàíèè [14, 15].  ïîñëåäíèå ãîäû ÏÑÀ è åãî êèíåòè÷åñêèå õàðàêòåðèñòèêè ðàññìàòðèâàþò êàê ïðîãíîñòè÷åñêè çíà÷èìûå ôàêòîðû ïðè îòáîðå áîëüíûõ – ÐÏÆ äëÿ ïðîâåäåíèÿ 11C-õîëèí ÏÝÒ ñ öåëüþ âûÿâëåíèÿ ìåñòíûõ ðåöèäèâîâ [4–7].

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    Giovacchini è ñîàâò. [8] ðàçëè÷èå çíà÷åíèé âðåìåíè óäâîåíèÿ ÏÑÀ ìåæäó 3-ì è 6-ì ìåñÿöàìè êîððåëèðîâàëî ñ 61% ðàçíèöåé íàëè÷èÿ ïîëîæèòåëüíûõ ðåçóëüòàòîâ ïî äàííûì 11C-õîëèí ÏÝÒ/ÊÒ, à ïðè ïîêàçàòåëå ìåíåå 3 ìåñ âûÿâëåíèå ïîëîæèòåëüíûõ ðåçóëüòàòîâ âîçðàñòàåò äî 81%.  íåäàâíåì èññëåäîâàíèè A.J. Breeuwsma è ñîàâò.
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    ïîêàçàòåëè âðåìåíè óäâîåíèÿ è ñêîðîñòè íàðàñòàíèÿ ÏÑÀ çíà÷èòåëüíî îòëè÷àëèñü ó ïàöèåíòîâ ñ îòðèöàòåëüíûìè ðåçóëüòàòàìè, ïî Таблица 1 Клиническая характеристика пациентов ПоказателиРПРТ Средний возраст, лет6771 Средний первичный ПСА, нг/мл14,723,6 Первичная стадия: T1-24 T23119 T32820 T421 Первичная оценка по шкале Глисона ≤ 62323 73532 8–1039 Уровень ПСА Всего (рецид

4
Maffezzini M, Bossi A, Collette L. Implications of prostate-specific antigen doubling time as indicator of failure after surgery or radiation therapy for prostate cancer. Eur Urol 2007; 51: 605–613
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    Ñ öåëüþ ðåøåíèÿ ýòîé ïðîáëåìû â ïîñëåäíèå ãîäû ñòàëè àêòèâíî èçó÷àòü êèíåòè÷åñêèå õàðàêòåðèñòèêè ÏÑÀ (ñêîðîñòü íàðàñòàíèÿ è âðåìÿ óäâîåíèÿ ÏÑÀ), îïðåäåëåíèå êîòîðûõ ïî ðåçóëüòàòàì ïîñëåäíèõ èññëåäîâàíèé ïîçâîëÿåò äèàãíîñòèðîâàòü âîçíèêíîâåíèå ðåöèäèâîâ è ïðîãíîçèðîâàòü âûæèâàåìîñòü áîëüíûõ ïðè ÐÏÆ
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    . Êèíåòè÷åñêèå õàðàêòåðèñòèêè ÏÑÀ ìîãóò èñïîëüçîâàòüñÿ äëÿ ïðîãíîçèðîâàíèÿ èñõîäîâ êàê ó áîëüíûõ ñ ëîêàëèçîâàííîé, òàê è ìåñòíî-ðàñïðîñòðàíåííîé ôîðìîé ÐÏÆ. Ïðè ýòîì ñêîðîñòü íàðàñòàíèÿ ÏÑÀ ìîæåò ïðåäîïðåäåëÿòü âîçíèêíîâåíèå ðåöèäèâîâ, îòäàëåííûõ ìåòàñòàçîâ è âûæèâàåìîñòü ïðè ÐÏÆ åùå äî íà÷àëà ëå÷åíèÿ [9].

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    Êîìáèíèðîâàííàÿ ÏÝÒ/ÊÒ ïîâûøàåò ýôôåêòèâíîñòü äèàãíîñòèêè, îñîáåííî â ñî÷åòàíèè ñ ðåçóëüòàòàìè, ïîëó÷åííûìè ïðè ìîðôîëîãè÷åñêîì èññëåäîâàíèè [14, 15].  ïîñëåäíèå ãîäû ÏÑÀ è åãî êèíåòè÷åñêèå õàðàêòåðèñòèêè ðàññìàòðèâàþò êàê ïðîãíîñòè÷åñêè çíà÷èìûå ôàêòîðû ïðè îòáîðå áîëüíûõ – ÐÏÆ äëÿ ïðîâåäåíèÿ 11C-õîëèí ÏÝÒ ñ öåëüþ âûÿâëåíèÿ ìåñòíûõ ðåöèäèâîâ
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    . Öåëü èññëåäîâàíèÿ – èçó÷èòü äèàãíîñòè÷åñêóþ çíà÷èìîñòü îïðåäåëåíèÿ óðîâíÿ ÏÑÀ â ïëàçìå êðîâè è åãî êèíåòè÷åñêèõ õàðàêòåðèñòèê (ñêîðîñòü íàðàñòàíèÿ è âðåìÿ óäâîåíèÿ ÏÑÀ) ïðè îòáîðå áîëüíûõ äëÿ êîíòðîëüíîé 11C-õîëèí ÏÝÒ/ÊÒ ñ öåëüþ âûÿâëåíèÿ ìåñòíûõ ðåöèäèâîâ ÐÏÆ, à òàêæå çàâèñèìîñòü ýòèõ ïîêàçàòåëåé îò ïåðâè÷íîãî ìåòîäà ëå÷åíèÿ – ÐÒ èëè ÐÏ.

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    Âðåìÿ óäâîåíèÿ ÏÑÀ ðàññ÷èòûâàëîñü ïî ôîðìóëå, ãäå ÷èñëèòåëü – íàòóðàëüíûé ëîãàðèôì 2 (0,693), çíàìåíàòåëü – λ. Êàê ïîêàçàíî íà ðèñ. 1, λ – ýòî óãîë îòíîøåíèÿ ëèíåéíîé ðåãðåññèè ëîãàðèôìîâ çíà÷åíèé ÏÑÀ êî âðåìåíè (â ìåñÿöàõ)
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    [4, 18]
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    . Âû÷èñëåíèÿ ïðîâîäèëè ñ èñïîëüçîâàíèåì Memorial Sloan-Kettering Medical Center prostate cancer prediction tool (http:// www.mskcc.org/mskcc/html/10088.cfm). ROC-àíàëèç ïîëó÷åííûõ äàííûõ áûë ïðîèçâåäåí ñ èñïîëüçîâàíèåì ñòàòèñòè÷åñêîé ïðîãðàììû SPSS-16.

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    Чем больше показатель AUC, тем лучшей прогностической силой обладает модель. Показатели AUC=0,7 и выше соответствуют хорошей прогностической значимости; ** SE (sensitivity) – чувствительность. Рис. 1. Расчет времени удвоения ПСА
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    . 11C-õîëèí ÏÝÒ/ÊÒ ó áîëüíûõ ñ óðîâíåì ÏÑÀ íèæå è âûøå 3 íã/ìë [13]. Îäíàêî íåäàâíèå èññëåäîâàíèÿ ïîñòàâèëè ïîä ñîìíåíèå íàëè÷èå êîððåëÿöèè ìåæäó îáú ̧ìîì îïóõîëè è óðîâíåì ÏÑÀ ó ïàöèåíòîâ, êîòîðûì ïðîâîäèëàñü ÐÏ ïî ïîâîäó ÐÏÆ íà ðàííèõ ñòàäèÿõ áîëåçíè [21].

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Palma D, Tyldesley S, Pickles T. Prostate Cohort Outcomes Initiative. Pretreatment prostate-specific antigen velocity is associated with development of distant metastases and prostate cancer mortality in men treated with radiotherapy and androgen-deprivation therapy. Cancer 2008; 112: 1941– 1948
Total in-text references: 2
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    Ñ öåëüþ ðåøåíèÿ ýòîé ïðîáëåìû â ïîñëåäíèå ãîäû ñòàëè àêòèâíî èçó÷àòü êèíåòè÷åñêèå õàðàêòåðèñòèêè ÏÑÀ (ñêîðîñòü íàðàñòàíèÿ è âðåìÿ óäâîåíèÿ ÏÑÀ), îïðåäåëåíèå êîòîðûõ ïî ðåçóëüòàòàì ïîñëåäíèõ èññëåäîâàíèé ïîçâîëÿåò äèàãíîñòèðîâàòü âîçíèêíîâåíèå ðåöèäèâîâ è ïðîãíîçèðîâàòü âûæèâàåìîñòü áîëüíûõ ïðè ÐÏÆ
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    . Êèíåòè÷åñêèå õàðàêòåðèñòèêè ÏÑÀ ìîãóò èñïîëüçîâàòüñÿ äëÿ ïðîãíîçèðîâàíèÿ èñõîäîâ êàê ó áîëüíûõ ñ ëîêàëèçîâàííîé, òàê è ìåñòíî-ðàñïðîñòðàíåííîé ôîðìîé ÐÏÆ. Ïðè ýòîì ñêîðîñòü íàðàñòàíèÿ ÏÑÀ ìîæåò ïðåäîïðåäåëÿòü âîçíèêíîâåíèå ðåöèäèâîâ, îòäàëåííûõ ìåòàñòàçîâ è âûæèâàåìîñòü ïðè ÐÏÆ åùå äî íà÷àëà ëå÷åíèÿ [9].

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    Êîìáèíèðîâàííàÿ ÏÝÒ/ÊÒ ïîâûøàåò ýôôåêòèâíîñòü äèàãíîñòèêè, îñîáåííî â ñî÷åòàíèè ñ ðåçóëüòàòàìè, ïîëó÷åííûìè ïðè ìîðôîëîãè÷åñêîì èññëåäîâàíèè [14, 15].  ïîñëåäíèå ãîäû ÏÑÀ è åãî êèíåòè÷åñêèå õàðàêòåðèñòèêè ðàññìàòðèâàþò êàê ïðîãíîñòè÷åñêè çíà÷èìûå ôàêòîðû ïðè îòáîðå áîëüíûõ – ÐÏÆ äëÿ ïðîâåäåíèÿ 11C-õîëèí ÏÝÒ ñ öåëüþ âûÿâëåíèÿ ìåñòíûõ ðåöèäèâîâ
    Exact
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    . Öåëü èññëåäîâàíèÿ – èçó÷èòü äèàãíîñòè÷åñêóþ çíà÷èìîñòü îïðåäåëåíèÿ óðîâíÿ ÏÑÀ â ïëàçìå êðîâè è åãî êèíåòè÷åñêèõ õàðàêòåðèñòèê (ñêîðîñòü íàðàñòàíèÿ è âðåìÿ óäâîåíèÿ ÏÑÀ) ïðè îòáîðå áîëüíûõ äëÿ êîíòðîëüíîé 11C-õîëèí ÏÝÒ/ÊÒ ñ öåëüþ âûÿâëåíèÿ ìåñòíûõ ðåöèäèâîâ ÐÏÆ, à òàêæå çàâèñèìîñòü ýòèõ ïîêàçàòåëåé îò ïåðâè÷íîãî ìåòîäà ëå÷åíèÿ – ÐÒ èëè ÐÏ.

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Petit JH, Chen MH, Loffredo M, Sussman B, Renshaw AA, D’Amico AV. Prostate-specific antigen recurrence and mortality after conventional dose radiation therapy in select men with low-risk prostate cancer. Cancer 2006; 107: 2180– 2185
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    Ñ öåëüþ ðåøåíèÿ ýòîé ïðîáëåìû â ïîñëåäíèå ãîäû ñòàëè àêòèâíî èçó÷àòü êèíåòè÷åñêèå õàðàêòåðèñòèêè ÏÑÀ (ñêîðîñòü íàðàñòàíèÿ è âðåìÿ óäâîåíèÿ ÏÑÀ), îïðåäåëåíèå êîòîðûõ ïî ðåçóëüòàòàì ïîñëåäíèõ èññëåäîâàíèé ïîçâîëÿåò äèàãíîñòèðîâàòü âîçíèêíîâåíèå ðåöèäèâîâ è ïðîãíîçèðîâàòü âûæèâàåìîñòü áîëüíûõ ïðè ÐÏÆ
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    . Êèíåòè÷åñêèå õàðàêòåðèñòèêè ÏÑÀ ìîãóò èñïîëüçîâàòüñÿ äëÿ ïðîãíîçèðîâàíèÿ èñõîäîâ êàê ó áîëüíûõ ñ ëîêàëèçîâàííîé, òàê è ìåñòíî-ðàñïðîñòðàíåííîé ôîðìîé ÐÏÆ. Ïðè ýòîì ñêîðîñòü íàðàñòàíèÿ ÏÑÀ ìîæåò ïðåäîïðåäåëÿòü âîçíèêíîâåíèå ðåöèäèâîâ, îòäàëåííûõ ìåòàñòàçîâ è âûæèâàåìîñòü ïðè ÐÏÆ åùå äî íà÷àëà ëå÷åíèÿ [9].

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    Êîìáèíèðîâàííàÿ ÏÝÒ/ÊÒ ïîâûøàåò ýôôåêòèâíîñòü äèàãíîñòèêè, îñîáåííî â ñî÷åòàíèè ñ ðåçóëüòàòàìè, ïîëó÷åííûìè ïðè ìîðôîëîãè÷åñêîì èññëåäîâàíèè [14, 15].  ïîñëåäíèå ãîäû ÏÑÀ è åãî êèíåòè÷åñêèå õàðàêòåðèñòèêè ðàññìàòðèâàþò êàê ïðîãíîñòè÷åñêè çíà÷èìûå ôàêòîðû ïðè îòáîðå áîëüíûõ – ÐÏÆ äëÿ ïðîâåäåíèÿ 11C-õîëèí ÏÝÒ ñ öåëüþ âûÿâëåíèÿ ìåñòíûõ ðåöèäèâîâ
    Exact
    [4–7]
    Suffix
    . Öåëü èññëåäîâàíèÿ – èçó÷èòü äèàãíîñòè÷åñêóþ çíà÷èìîñòü îïðåäåëåíèÿ óðîâíÿ ÏÑÀ â ïëàçìå êðîâè è åãî êèíåòè÷åñêèõ õàðàêòåðèñòèê (ñêîðîñòü íàðàñòàíèÿ è âðåìÿ óäâîåíèÿ ÏÑÀ) ïðè îòáîðå áîëüíûõ äëÿ êîíòðîëüíîé 11C-õîëèí ÏÝÒ/ÊÒ ñ öåëüþ âûÿâëåíèÿ ìåñòíûõ ðåöèäèâîâ ÐÏÆ, à òàêæå çàâèñèìîñòü ýòèõ ïîêàçàòåëåé îò ïåðâè÷íîãî ìåòîäà ëå÷åíèÿ – ÐÒ èëè ÐÏ.

7
Castellucci P, Fuccio C, Nanni C et al. Influence of trigger PSA and PSA kinetics on 11C-Choline PET/CT detection rate in patients with biochemical relapse after radical prostatectomy. J Nucl Med 2009; 50: 1394-1400
Total in-text references: 3
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    Ñ öåëüþ ðåøåíèÿ ýòîé ïðîáëåìû â ïîñëåäíèå ãîäû ñòàëè àêòèâíî èçó÷àòü êèíåòè÷åñêèå õàðàêòåðèñòèêè ÏÑÀ (ñêîðîñòü íàðàñòàíèÿ è âðåìÿ óäâîåíèÿ ÏÑÀ), îïðåäåëåíèå êîòîðûõ ïî ðåçóëüòàòàì ïîñëåäíèõ èññëåäîâàíèé ïîçâîëÿåò äèàãíîñòèðîâàòü âîçíèêíîâåíèå ðåöèäèâîâ è ïðîãíîçèðîâàòü âûæèâàåìîñòü áîëüíûõ ïðè ÐÏÆ
    Exact
    [4–8]
    Suffix
    . Êèíåòè÷åñêèå õàðàêòåðèñòèêè ÏÑÀ ìîãóò èñïîëüçîâàòüñÿ äëÿ ïðîãíîçèðîâàíèÿ èñõîäîâ êàê ó áîëüíûõ ñ ëîêàëèçîâàííîé, òàê è ìåñòíî-ðàñïðîñòðàíåííîé ôîðìîé ÐÏÆ. Ïðè ýòîì ñêîðîñòü íàðàñòàíèÿ ÏÑÀ ìîæåò ïðåäîïðåäåëÿòü âîçíèêíîâåíèå ðåöèäèâîâ, îòäàëåííûõ ìåòàñòàçîâ è âûæèâàåìîñòü ïðè ÐÏÆ åùå äî íà÷àëà ëå÷åíèÿ [9].

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    Êîìáèíèðîâàííàÿ ÏÝÒ/ÊÒ ïîâûøàåò ýôôåêòèâíîñòü äèàãíîñòèêè, îñîáåííî â ñî÷åòàíèè ñ ðåçóëüòàòàìè, ïîëó÷åííûìè ïðè ìîðôîëîãè÷åñêîì èññëåäîâàíèè [14, 15].  ïîñëåäíèå ãîäû ÏÑÀ è åãî êèíåòè÷åñêèå õàðàêòåðèñòèêè ðàññìàòðèâàþò êàê ïðîãíîñòè÷åñêè çíà÷èìûå ôàêòîðû ïðè îòáîðå áîëüíûõ – ÐÏÆ äëÿ ïðîâåäåíèÿ 11C-õîëèí ÏÝÒ ñ öåëüþ âûÿâëåíèÿ ìåñòíûõ ðåöèäèâîâ
    Exact
    [4–7]
    Suffix
    . Öåëü èññëåäîâàíèÿ – èçó÷èòü äèàãíîñòè÷åñêóþ çíà÷èìîñòü îïðåäåëåíèÿ óðîâíÿ ÏÑÀ â ïëàçìå êðîâè è åãî êèíåòè÷åñêèõ õàðàêòåðèñòèê (ñêîðîñòü íàðàñòàíèÿ è âðåìÿ óäâîåíèÿ ÏÑÀ) ïðè îòáîðå áîëüíûõ äëÿ êîíòðîëüíîé 11C-õîëèí ÏÝÒ/ÊÒ ñ öåëüþ âûÿâëåíèÿ ìåñòíûõ ðåöèäèâîâ ÐÏÆ, à òàêæå çàâèñèìîñòü ýòèõ ïîêàçàòåëåé îò ïåðâè÷íîãî ìåòîäà ëå÷åíèÿ – ÐÒ èëè ÐÏ.

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    Âðåìÿ óäâîåíèÿ ÏÑÀ îêàçàëîñü íàèáîëåå äîñòîâåðíûì ïîêàçàòåëåì, âñå åãî çíà÷åíèÿ ïðè ñðàâíåíèÿõ â ãðóïïàõ áîëüíûõ ïîñëå ÐÏ è ÐÒ êîððåëèðîâàëè ñ ðåçóëüòàòàìè ÏÝÒ/ÊÒ. Ïîëó÷åííûå â èññëåäîâàíèè çíà÷åíèÿ êèíåòè÷åñêèõ õàðàêòåðèñòèê ÏÑÀ ïîñëå ÐÏ ñîïîñòàâèìû ñ ðåçóëüòàòàìè P. Castellucci è ñîàâò.
    Exact
    [7]
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    , ãäå áûëà íàéäåíà çíà÷èòåëüíàÿ êîððåëÿöèÿ ìåæäó ÷àñòîòîé âûÿâëåíèÿ ðåöèäèâîâ ïî ðåçóëüòàòàì 11Cõîëèí ÏÝÒ/ÊÒ è êèíåòè÷åñêèìè õàðàêòåðèñòèêàìè ÏÑÀ ó ïàöèåíòîâ ñ áèîõèìè÷åñêèìè ïðèçíàêàìè ðåöèäèâà ïîñëå ÐÏ.

8
Giovacchini G, Picchio M, Scattoni V et al. PSA doubling time for prediction of [(11)C]choline PET/CT findings in prostate cancer patients with biochemical failure after radical prostatectomy. Eur J Nucl Med Mol Imaging 2010; 37: 11061116
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    Ñ öåëüþ ðåøåíèÿ ýòîé ïðîáëåìû â ïîñëåäíèå ãîäû ñòàëè àêòèâíî èçó÷àòü êèíåòè÷åñêèå õàðàêòåðèñòèêè ÏÑÀ (ñêîðîñòü íàðàñòàíèÿ è âðåìÿ óäâîåíèÿ ÏÑÀ), îïðåäåëåíèå êîòîðûõ ïî ðåçóëüòàòàì ïîñëåäíèõ èññëåäîâàíèé ïîçâîëÿåò äèàãíîñòèðîâàòü âîçíèêíîâåíèå ðåöèäèâîâ è ïðîãíîçèðîâàòü âûæèâàåìîñòü áîëüíûõ ïðè ÐÏÆ
    Exact
    [4–8]
    Suffix
    . Êèíåòè÷åñêèå õàðàêòåðèñòèêè ÏÑÀ ìîãóò èñïîëüçîâàòüñÿ äëÿ ïðîãíîçèðîâàíèÿ èñõîäîâ êàê ó áîëüíûõ ñ ëîêàëèçîâàííîé, òàê è ìåñòíî-ðàñïðîñòðàíåííîé ôîðìîé ÐÏÆ. Ïðè ýòîì ñêîðîñòü íàðàñòàíèÿ ÏÑÀ ìîæåò ïðåäîïðåäåëÿòü âîçíèêíîâåíèå ðåöèäèâîâ, îòäàëåííûõ ìåòàñòàçîâ è âûæèâàåìîñòü ïðè ÐÏÆ åùå äî íà÷àëà ëå÷åíèÿ [9].

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    Àâòîðû äîêàçàëè, ÷òî óðîâåíü âûÿâëåíèÿ ðåöèäèâîâ ñ ïîìîùüþ 11C-õîëèí ÏÝÒ/ÊÒ áûë çíà÷èòåëüíî âûøå ó áîëüíûõ ïðè ñêîðîñòè íàðàñòàíèÿ ÏÑÀ áîëåå 1,1 íã/ìë/ãîä è âðåìåíè óäâîåíèÿ ÏÑÀ ìåíåå 3 ìåñ. G . Giovacchini è ñîàâò.
    Exact
    [8]
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    òàêæå äîêàçàëè, ÷òî âðåìÿ óäâîåíèÿ ÏÑÀ ÿâëÿåòñÿ íåçàâèñèìûì ïðîãíîñòè÷åñêèì ôàêòîðîì, âëèÿþùèì íà ðåçóëüòàòû 11C-õîëèí ÏÝÒ/ÊÒ.  èõ èññëåäîâàíèè ó ïàöèåíòîâ ñ áèîõèìè÷åñêèìè ïðèçíàêàìè ðåöèäèâà ïîñëå ÐÏ ðåçóëüòàòû 11C-õîëèí ÏÝÒ/ÊÒ áûëè ïîëîæèòåëüíûìè ó 75 èç 170 (44%) áîëüíûõ.

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     îòëè÷èå îò îáùåãî ÏÑÀ, ïîêàçàòåëü âðåìåíè óäâîåíèÿ ÏÑÀ ðàçëè÷àëñÿ ó ïàöèåíòîâ ñ ïîâûøåííûì íàêîïëåíèåì ðàäèîôàðìïðåïàðàòà â êîñòÿõ îò ïàöèåíòîâ ñ ïîâûøåííûì íàêîïëåíèåì â ïðîñòàòè÷åñêîì ëîæå.  èññëåäîâàíèè G. Giovacchini è ñîàâò.
    Exact
    [8]
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    ðàçëè÷èå çíà÷åíèé âðåìåíè óäâîåíèÿ ÏÑÀ ìåæäó 3-ì è 6-ì ìåñÿöàìè êîððåëèðîâàëî ñ 61% ðàçíèöåé íàëè÷èÿ ïîëîæèòåëüíûõ ðåçóëüòàòîâ ïî äàííûì 11C-õîëèí ÏÝÒ/ÊÒ, à ïðè ïîêàçàòåëå ìåíåå 3 ìåñ âûÿâëåíèå ïîëîæèòåëüíûõ ðåçóëüòàòîâ âîçðàñòàåò äî 81%.

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    Ïðè ñðàâíåíèè ñ ïîìîùüþ ROC-àíàëèçà ïîêàçàòåëåé ó áîëüíûõ, ïåðåíåñøèõ ÐÏ è ÐÒ, îêàçàëîñü, ÷òî ïîêàçàòåëü âðåìåíè óäâîåíèÿ ÏÑÀ ÿâèëñÿ íàèáîëåå ñòàòèñòè÷åñêè çíà÷èìûì, óêàçûâàþùèì íà íàëè÷èå ðåöèäèâà. Íàøè ðåçóëüòàòû îòëè÷àþòñÿ îò òàêîâûõ, ïîëó÷åííûõ G. Giovacchini è ñîàâò.
    Exact
    [8]
    Suffix
    . Ïî èõ äàííûì âåðîÿòíîñòü ðåöèäèâà ïîâûøàëàñü ó ïàöèåíòîâ ñ óðîâíåì ÏÑÀ ìåíåå ÷åì 2,4 íã/ìë â êîìáèíàöèè ñî âðåìåíåì óäâîåíèÿ ÏÑÀ ìåíåå 3 ìåñ è/èëè ñêîðîñòüþ íàðàñòàíèÿ ÏÑÀ âûøå 1 íã/ìë/ãîä. Ó ïàöèåíòîâ ñ óðîâíåì ÏÑÀ âûøå 2,4 íã/ìë àâòîðû íå âûÿâèëè äîïîëíèòåëüíîé ïðîãíîñòè÷åñêîé çíà÷èìîñòè ïîêàçàòåëåé êèíåòè÷åñêèõ õàðàêòåðèñòèê ÏÑÀ.

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     íåäàâíåì ïîäîáíîì èññëåäîâàíèè 11C-õîëèí ÏÝÒ/ÊÒ âûÿâèëà ðåöèäèâ ÐÏÆ ó 19 èç 21 (90%), ò.å. ó áîëüøåãî ÷èñëà ïàöèåíòîâ [23]. Äðóãèì íåäîñòàòêîì íàøåãî èññëåäîâàíèÿ áûëî òî, ÷òî ãèñòîëîãè÷åñêîå ïîäòâåðæäåíèå äèàãíîçà èìåëî ìåñòî òîëüêî ó 59% ïàöèåíòîâ. Ñ ïîäîáíîé ñèòóàöèåé ñòàëêèâàëèñü G. Giovacchini è ñîàâò.
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    , êîãäà â 89% ñëó÷àåâ äèàãíîç ïîäòâåðæäàëè ñ ïîìîùüþ äîïîëíèòåëüíûõ ìåòîäîâ îáñëåäîâàíèÿ è äàííûõ êëèíè÷åñêîãî íàáëþäåíèÿ, è òîëüêî â 11% ñëó÷àåâ – ñ ïîìîùüþ ãèñòîëîãè÷åñêîãî èññëåäîâàíèÿ. Ó÷èòûâàÿ òîò ôàêò, ÷òî áîëüøîå êîëè÷åñòâî ëîêàëüíûõ ðåöèäèâîâ ìîæåò áûòü ïðîïóùåíî è ïðè èñïîëüçîâàíèè ìóëüòèôîêàëüíîé áèîïñèè, íåëüçÿ ñ÷èòàòü ýòîò ìåòîä âåðèôèêàöèè ïîëíîñòüþ äîñòîâåðíûì, ò.å. äëÿ êàæäîãî ïàöèå

9
Fitzpatrick JM, Banu E, Oudard S. Prostate-specific antigen kinetics in localized and advanced prostate cancer. BJU Int 2009; 103: 578-587
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    Êèíåòè÷åñêèå õàðàêòåðèñòèêè ÏÑÀ ìîãóò èñïîëüçîâàòüñÿ äëÿ ïðîãíîçèðîâàíèÿ èñõîäîâ êàê ó áîëüíûõ ñ ëîêàëèçîâàííîé, òàê è ìåñòíî-ðàñïðîñòðàíåííîé ôîðìîé ÐÏÆ. Ïðè ýòîì ñêîðîñòü íàðàñòàíèÿ ÏÑÀ ìîæåò ïðåäîïðåäåëÿòü âîçíèêíîâåíèå ðåöèäèâîâ, îòäàëåííûõ ìåòàñòàçîâ è âûæèâàåìîñòü ïðè ÐÏÆ åùå äî íà÷àëà ëå÷åíèÿ
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    . Ðàñ÷åò âðåìåíè óäâîåíèÿ ÏÑÀ öåëåñîîáðàçåí äëÿ âûÿâëåíèÿ áîëüíûõ ñ ÐÏÆ ñ âûñîêèì ðèñêîì ñìåðòè îò äàííîãî çàáîëåâàíèÿ, ÷òî ñïîñîáñòâóåò îïòèìèçàöèè ëå÷åíèÿ òàêèõ ïàöèåíòîâ [9]. 11C-õîëèí ïîçèòðîííî-ýìèññèîííàÿ òîìîãðàôèÿ (ÏÝÒ) ïîçâîëÿåò ñ âûñîêîé òî÷íîñòüþ âûÿâëÿòü ðåöèäèâû ÐÏÆ ó ïàöèåíòîâ ïîñëå ÐÒ, íî åå äèàãíîñòè÷åñêèå âîçìîæíîñòè õóæå ïðè îáñëåäîâàíèè ïàöèåíòîâ, ïåðåíåñøèõ ÐÏ [3,10–13].

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    Ïðè ýòîì ñêîðîñòü íàðàñòàíèÿ ÏÑÀ ìîæåò ïðåäîïðåäåëÿòü âîçíèêíîâåíèå ðåöèäèâîâ, îòäàëåííûõ ìåòàñòàçîâ è âûæèâàåìîñòü ïðè ÐÏÆ åùå äî íà÷àëà ëå÷åíèÿ [9]. Ðàñ÷åò âðåìåíè óäâîåíèÿ ÏÑÀ öåëåñîîáðàçåí äëÿ âûÿâëåíèÿ áîëüíûõ ñ ÐÏÆ ñ âûñîêèì ðèñêîì ñìåðòè îò äàííîãî çàáîëåâàíèÿ, ÷òî ñïîñîáñòâóåò îïòèìèçàöèè ëå÷åíèÿ òàêèõ ïàöèåíòîâ
    Exact
    [9]
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    . 11C-õîëèí ïîçèòðîííî-ýìèññèîííàÿ òîìîãðàôèÿ (ÏÝÒ) ïîçâîëÿåò ñ âûñîêîé òî÷íîñòüþ âûÿâëÿòü ðåöèäèâû ÐÏÆ ó ïàöèåíòîâ ïîñëå ÐÒ, íî åå äèàãíîñòè÷åñêèå âîçìîæíîñòè õóæå ïðè îáñëåäîâàíèè ïàöèåíòîâ, ïåðåíåñøèõ ÐÏ [3,10–13].

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    Îäíàêî ïðè óðîâíå ÏÑÀ ìåíåå 2 íã/ìë âûÿâëÿåìîñòü ðåöèäèâîâ ó áîëüíûõ áûëà çíà÷èòåëüíî íèæå, ÷åì ýòî îïèñàíî â ëèòåðàòóðå. Ïîêàçàòåëè âðåìåíè óäâîåíèÿ è ñêîðîñòè íàðàñòàíèÿ ÏÑÀ ìîãóò ðàçëè÷àòüñÿ èç-çà âûñîêîé áèîëîãè÷åñêîé âàðèàáåëüíîñòè ÏÑÀ è íàëè÷èÿ áîëüøîãî êîëè÷åñòâà ìåòîäîâ îïðåäåëåíèÿ åãî óðîâíÿ
    Exact
    [9]
    Suffix
    . Äàæå íåáîëüøèå îòëè÷èÿ â ìåòîäàõ ìîãóò ïðèâîäèòü ê îøèáî÷íîìó (äî íåñêîëüêèõ ìåñÿöåâ) îïðåäåëåíèþ ôàêòè÷åñêîãî âðåìåíè óäâîåíèÿ ÏÑÀ, ÷òî ìîæåò îòðèöàòåëüíî ïîâëèÿòü íà òàêòèêó âåäåíèÿ áîëüíîãî ïðè ïåðâè÷íîì îáíàðóæåíèè ÐÏÆ [9].

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    Äàæå íåáîëüøèå îòëè÷èÿ â ìåòîäàõ ìîãóò ïðèâîäèòü ê îøèáî÷íîìó (äî íåñêîëüêèõ ìåñÿöåâ) îïðåäåëåíèþ ôàêòè÷åñêîãî âðåìåíè óäâîåíèÿ ÏÑÀ, ÷òî ìîæåò îòðèöàòåëüíî ïîâëèÿòü íà òàêòèêó âåäåíèÿ áîëüíîãî ïðè ïåðâè÷íîì îáíàðóæåíèè ÐÏÆ
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    . Îäíàêî ïðè ðåöèäèâàõ ÐÏÆ ñêîðîñòü íàðàñòàíèÿ è âðåìÿ óäâîåíèÿ ÏÑÀ îêàçàëèñü êëèíè÷åñêè çíà÷èìûìè ïðîãíîñòè÷åñêèìè ôàêòîðàìè â îòíîøåíèè ðåöèäèâèðîâàíèÿ.  íàøåì èññëåäîâàíèè ìû èñïîëüçîâàëè ìîäåëè, êîòîðûå ïîêàçàëè ñâîþ âûñîêóþ òî÷íîñòü [19].

10
Picchio M, Messa C, Landoni C et al. Value of 11C choline-positron emission tomography for restaging prostate cancer: a comparison with 18F fluorodeoxyglucose-positron emission tomography. J Urol 2003; 169: 1337–1340
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    Ðàñ÷åò âðåìåíè óäâîåíèÿ ÏÑÀ öåëåñîîáðàçåí äëÿ âûÿâëåíèÿ áîëüíûõ ñ ÐÏÆ ñ âûñîêèì ðèñêîì ñìåðòè îò äàííîãî çàáîëåâàíèÿ, ÷òî ñïîñîáñòâóåò îïòèìèçàöèè ëå÷åíèÿ òàêèõ ïàöèåíòîâ [9]. 11C-õîëèí ïîçèòðîííî-ýìèññèîííàÿ òîìîãðàôèÿ (ÏÝÒ) ïîçâîëÿåò ñ âûñîêîé òî÷íîñòüþ âûÿâëÿòü ðåöèäèâû ÐÏÆ ó ïàöèåíòîâ ïîñëå ÐÒ, íî åå äèàãíîñòè÷åñêèå âîçìîæíîñòè õóæå ïðè îáñëåäîâàíèè ïàöèåíòîâ, ïåðåíåñøèõ ÐÏ
    Exact
    [3,10–13]
    Suffix
    . Êîìáèíèðîâàííàÿ ÏÝÒ/ÊÒ ïîâûøàåò ýôôåêòèâíîñòü äèàãíîñòèêè, îñîáåííî â ñî÷åòàíèè ñ ðåçóëüòàòàìè, ïîëó÷åííûìè ïðè ìîðôîëîãè÷åñêîì èññëåäîâàíèè [14, 15].  ïîñëåäíèå ãîäû ÏÑÀ è åãî êèíåòè÷åñêèå õàðàêòåðèñòèêè ðàññìàòðèâàþò êàê ïðîãíîñòè÷åñêè çíà÷èìûå ôàêòîðû ïðè îòáîðå áîëüíûõ – ÐÏÆ äëÿ ïðîâåäåíèÿ 11C-õîëèí ÏÝÒ ñ öåëüþ âûÿâëåíèÿ ìåñòíûõ ðåöèäèâîâ [4–7].

11
Jong IJ, Pruim J, Elsinga PH, Vaalburg W, Mensink HJ. 11C-choline positron emission tomography for the evaluation after treatment of localized prostate cancer. Eur Urol 2003; 44: 32–38
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    Ðàñ÷åò âðåìåíè óäâîåíèÿ ÏÑÀ öåëåñîîáðàçåí äëÿ âûÿâëåíèÿ áîëüíûõ ñ ÐÏÆ ñ âûñîêèì ðèñêîì ñìåðòè îò äàííîãî çàáîëåâàíèÿ, ÷òî ñïîñîáñòâóåò îïòèìèçàöèè ëå÷åíèÿ òàêèõ ïàöèåíòîâ [9]. 11C-õîëèí ïîçèòðîííî-ýìèññèîííàÿ òîìîãðàôèÿ (ÏÝÒ) ïîçâîëÿåò ñ âûñîêîé òî÷íîñòüþ âûÿâëÿòü ðåöèäèâû ÐÏÆ ó ïàöèåíòîâ ïîñëå ÐÒ, íî åå äèàãíîñòè÷åñêèå âîçìîæíîñòè õóæå ïðè îáñëåäîâàíèè ïàöèåíòîâ, ïåðåíåñøèõ ÐÏ
    Exact
    [3,10–13]
    Suffix
    . Êîìáèíèðîâàííàÿ ÏÝÒ/ÊÒ ïîâûøàåò ýôôåêòèâíîñòü äèàãíîñòèêè, îñîáåííî â ñî÷åòàíèè ñ ðåçóëüòàòàìè, ïîëó÷åííûìè ïðè ìîðôîëîãè÷åñêîì èññëåäîâàíèè [14, 15].  ïîñëåäíèå ãîäû ÏÑÀ è åãî êèíåòè÷åñêèå õàðàêòåðèñòèêè ðàññìàòðèâàþò êàê ïðîãíîñòè÷åñêè çíà÷èìûå ôàêòîðû ïðè îòáîðå áîëüíûõ – ÐÏÆ äëÿ ïðîâåäåíèÿ 11C-õîëèí ÏÝÒ ñ öåëüþ âûÿâëåíèÿ ìåñòíûõ ðåöèäèâîâ [4–7].

12
Rinnab L, Mottaghy FM, Blumstein NM et al. Evaluation of 11C-choline positron-emission/computed tomography in patients with increasing prostate-specific antigen levels after primary treatment for prostate cancer. BJU Int 2007; 100: 786– 793
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    Ðàñ÷åò âðåìåíè óäâîåíèÿ ÏÑÀ öåëåñîîáðàçåí äëÿ âûÿâëåíèÿ áîëüíûõ ñ ÐÏÆ ñ âûñîêèì ðèñêîì ñìåðòè îò äàííîãî çàáîëåâàíèÿ, ÷òî ñïîñîáñòâóåò îïòèìèçàöèè ëå÷åíèÿ òàêèõ ïàöèåíòîâ [9]. 11C-õîëèí ïîçèòðîííî-ýìèññèîííàÿ òîìîãðàôèÿ (ÏÝÒ) ïîçâîëÿåò ñ âûñîêîé òî÷íîñòüþ âûÿâëÿòü ðåöèäèâû ÐÏÆ ó ïàöèåíòîâ ïîñëå ÐÒ, íî åå äèàãíîñòè÷åñêèå âîçìîæíîñòè õóæå ïðè îáñëåäîâàíèè ïàöèåíòîâ, ïåðåíåñøèõ ÐÏ
    Exact
    [3,10–13]
    Suffix
    . Êîìáèíèðîâàííàÿ ÏÝÒ/ÊÒ ïîâûøàåò ýôôåêòèâíîñòü äèàãíîñòèêè, îñîáåííî â ñî÷åòàíèè ñ ðåçóëüòàòàìè, ïîëó÷åííûìè ïðè ìîðôîëîãè÷åñêîì èññëåäîâàíèè [14, 15].  ïîñëåäíèå ãîäû ÏÑÀ è åãî êèíåòè÷åñêèå õàðàêòåðèñòèêè ðàññìàòðèâàþò êàê ïðîãíîñòè÷åñêè çíà÷èìûå ôàêòîðû ïðè îòáîðå áîëüíûõ – ÐÏÆ äëÿ ïðîâåäåíèÿ 11C-õîëèí ÏÝÒ ñ öåëüþ âûÿâëåíèÿ ìåñòíûõ ðåöèäèâîâ [4–7].

13
Krause BJ, Souvatzoglou M, Tuncel M et al. The detection rate of [(11)C]choline-PET/CT depends on the serum PSAvalue in patients with biochemical recurrence of prostate cancer. Eur J Nucl Med Mol Imaging 2008; 35: 18–23
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    Ðàñ÷åò âðåìåíè óäâîåíèÿ ÏÑÀ öåëåñîîáðàçåí äëÿ âûÿâëåíèÿ áîëüíûõ ñ ÐÏÆ ñ âûñîêèì ðèñêîì ñìåðòè îò äàííîãî çàáîëåâàíèÿ, ÷òî ñïîñîáñòâóåò îïòèìèçàöèè ëå÷åíèÿ òàêèõ ïàöèåíòîâ [9]. 11C-õîëèí ïîçèòðîííî-ýìèññèîííàÿ òîìîãðàôèÿ (ÏÝÒ) ïîçâîëÿåò ñ âûñîêîé òî÷íîñòüþ âûÿâëÿòü ðåöèäèâû ÐÏÆ ó ïàöèåíòîâ ïîñëå ÐÒ, íî åå äèàãíîñòè÷åñêèå âîçìîæíîñòè õóæå ïðè îáñëåäîâàíèè ïàöèåíòîâ, ïåðåíåñøèõ ÐÏ
    Exact
    [3,10–13]
    Suffix
    . Êîìáèíèðîâàííàÿ ÏÝÒ/ÊÒ ïîâûøàåò ýôôåêòèâíîñòü äèàãíîñòèêè, îñîáåííî â ñî÷åòàíèè ñ ðåçóëüòàòàìè, ïîëó÷åííûìè ïðè ìîðôîëîãè÷åñêîì èññëåäîâàíèè [14, 15].  ïîñëåäíèå ãîäû ÏÑÀ è åãî êèíåòè÷åñêèå õàðàêòåðèñòèêè ðàññìàòðèâàþò êàê ïðîãíîñòè÷åñêè çíà÷èìûå ôàêòîðû ïðè îòáîðå áîëüíûõ – ÐÏÆ äëÿ ïðîâåäåíèÿ 11C-õîëèí ÏÝÒ ñ öåëüþ âûÿâëåíèÿ ìåñòíûõ ðåöèäèâîâ [4–7].

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     íàøåì èññëåäîâàíèè îáùèé ÏÑÀ íå îêàçàëñÿ ïðîãíîñòè÷åñêè çíà÷èìûì ôàêòîðîì, îäíàêî ïðè ñðàâíåíèè ýòèõ ðåçóëüòàòîâ ñ äàííûìè â óïîìÿíóòîé ñòàòüå åãî ñðåäíèé óðîâåíü áûë çíà÷èòåëüíî âûøå – 4,8 íã/ìë, à ïî äàííûì ëèòåðàòóðû ïðè òàêîì çíà÷åíèè ïîêàçàòåëÿ ýôôåêòèâíîñòü âûÿâëåíèÿ ðåöèäèâîâ 11C-õîëèí ÏÝÒ/ÊÒ óæå íå âîçðàñòàåò
    Exact
    [13]
    Suffix
    .  îòëè÷èå îò îáùåãî ÏÑÀ, ïîêàçàòåëü âðåìåíè óäâîåíèÿ ÏÑÀ ðàçëè÷àëñÿ ó ïàöèåíòîâ ñ ïîâûøåííûì íàêîïëåíèåì ðàäèîôàðìïðåïàðàòà â êîñòÿõ îò ïàöèåíòîâ ñ ïîâûøåííûì íàêîïëåíèåì â ïðîñòàòè÷åñêîì ëîæå.

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    Показатели AUC=0,7 и выше соответствуют хорошей прогностической значимости; ** SE (sensitivity) – чувствительность. Рис. 1. Расчет времени удвоения ПСА [4]. 11C-õîëèí ÏÝÒ/ÊÒ ó áîëüíûõ ñ óðîâíåì ÏÑÀ íèæå è âûøå 3 íã/ìë
    Exact
    [13]
    Suffix
    . Îäíàêî íåäàâíèå èññëåäîâàíèÿ ïîñòàâèëè ïîä ñîìíåíèå íàëè÷èå êîððåëÿöèè ìåæäó îáú ̧ìîì îïóõîëè è óðîâíåì ÏÑÀ ó ïàöèåíòîâ, êîòîðûì ïðîâîäèëàñü ÐÏ ïî ïîâîäó ÐÏÆ íà ðàííèõ ñòàäèÿõ áîëåçíè [21].  äîñòóïíîé ëèòåðàòóðå ñâåäåíèé î ñîîòíîøåíèè îáú ̧ìà îïóõîëè è óðîâíÿ ÏÑÀ ïðè ðåöèäèâå ÐÏÆ îáíàðóæèòü íå óäàëîñü.

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Tsukamoto E, Ochi S. PET/CT today: system and its impact on cancer diagnosis. Ann Nucl Med 2006; 20: 255-267
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    îïòèìèçàöèè ëå÷åíèÿ òàêèõ ïàöèåíòîâ [9]. 11C-õîëèí ïîçèòðîííî-ýìèññèîííàÿ òîìîãðàôèÿ (ÏÝÒ) ïîçâîëÿåò ñ âûñîêîé òî÷íîñòüþ âûÿâëÿòü ðåöèäèâû ÐÏÆ ó ïàöèåíòîâ ïîñëå ÐÒ, íî åå äèàãíîñòè÷åñêèå âîçìîæíîñòè õóæå ïðè îáñëåäîâàíèè ïàöèåíòîâ, ïåðåíåñøèõ ÐÏ [3,10–13]. Êîìáèíèðîâàííàÿ ÏÝÒ/ÊÒ ïîâûøàåò ýôôåêòèâíîñòü äèàãíîñòèêè, îñîáåííî â ñî÷åòàíèè ñ ðåçóëüòàòàìè, ïîëó÷åííûìè ïðè ìîðôîëîãè÷åñêîì èññëåäîâàíèè
    Exact
    [14, 15]
    Suffix
    .  ïîñëåäíèå ãîäû ÏÑÀ è åãî êèíåòè÷åñêèå õàðàêòåðèñòèêè ðàññìàòðèâàþò êàê ïðîãíîñòè÷åñêè çíà÷èìûå ôàêòîðû ïðè îòáîðå áîëüíûõ – ÐÏÆ äëÿ ïðîâåäåíèÿ 11C-õîëèí ÏÝÒ ñ öåëüþ âûÿâëåíèÿ ìåñòíûõ ðåöèäèâîâ [4–7].

15
Townsend DW. Dual-modality imaging: combining anatomy and function. J Nucl Med 2008; 49: 938-955
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  1. In-text reference with the coordinate start=7235
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    îïòèìèçàöèè ëå÷åíèÿ òàêèõ ïàöèåíòîâ [9]. 11C-õîëèí ïîçèòðîííî-ýìèññèîííàÿ òîìîãðàôèÿ (ÏÝÒ) ïîçâîëÿåò ñ âûñîêîé òî÷íîñòüþ âûÿâëÿòü ðåöèäèâû ÐÏÆ ó ïàöèåíòîâ ïîñëå ÐÒ, íî åå äèàãíîñòè÷åñêèå âîçìîæíîñòè õóæå ïðè îáñëåäîâàíèè ïàöèåíòîâ, ïåðåíåñøèõ ÐÏ [3,10–13]. Êîìáèíèðîâàííàÿ ÏÝÒ/ÊÒ ïîâûøàåò ýôôåêòèâíîñòü äèàãíîñòèêè, îñîáåííî â ñî÷åòàíèè ñ ðåçóëüòàòàìè, ïîëó÷åííûìè ïðè ìîðôîëîãè÷åñêîì èññëåäîâàíèè
    Exact
    [14, 15]
    Suffix
    .  ïîñëåäíèå ãîäû ÏÑÀ è åãî êèíåòè÷åñêèå õàðàêòåðèñòèêè ðàññìàòðèâàþò êàê ïðîãíîñòè÷åñêè çíà÷èìûå ôàêòîðû ïðè îòáîðå áîëüíûõ – ÐÏÆ äëÿ ïðîâåäåíèÿ 11C-õîëèí ÏÝÒ ñ öåëüþ âûÿâëåíèÿ ìåñòíûõ ðåöèäèâîâ [4–7].

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Consensus statement. Guidelines for PSA following radiation therapy. American Society for Therapeutic Radiology and Oncology Consensus Panel. Int J Radiat Oncol Biol Phys 1997; 37: 1035-1041
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    Ñðàâíèâàëè êëèíèêî-ìîðôîëîãè÷åñêèå ïàðàìåòðû â îáåèõ ãðóïïàõ áîëüíûõ. Îòáèðàëè ïàöèåíòîâ ïîñëå ÐÒ ñ áèîõèìè÷åñêèìè ïðèçíàêàìè ðåöèäèâà îïóõîëè, îñíîâûâàÿñü íà êðèòåðèè, ïðåäëîæåííîì Àìåðèêàíñêèì îáùåñòâîì ëå÷åáíîé ðàäèîëîãèè è îíêîëîãèè â 1997 ã.
    Exact
    [16]
    Suffix
    . Ïàöèåíòû ïîñëå ÐÏ áûëè âêëþ÷åíû â èññëåäîâàíèå, åñëè óðîâåíü ÏÑÀ ó íèõ ñòàíîâèëñÿ âûøå 0,2 íã/ìë.  òå÷åíèå 1 ãîäà ïåðåä ÏÝÒ-îáñëåäîâàíèåì íèêîìó èç ïàöèåíòîâ íå ïðîâîäèëàñü àäúþâàíòíàÿ ãîðìîíàëüíàÿ òåðàïèÿ.

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Hara T. 11C-choline and 2-deoxy-2-[18F]fluoro-Dglucose in tumor imaging with positron emission tomography. Mol Imaging Biol 2002; 4: 267-273
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    Ãèñòîëîãè÷åñêàÿ âåðèôèêàöèÿ äèàãíîçà è îïðåäåëåíèå ñòåïåíè çëîêà÷åñòâåííîñòè íîâîîáðàçîâàíèÿ ïî øêàëå Ãëèñîíà ïðîâîäèëè íà îêðàøåííûõ ãåìàòîêñèëèíîì-ýîçèíîì ïðåïàðàòàõ. 11C-õîëèí ïîëó÷àëè ñ èñïîëüçîâàíèåì öèêëîòðîíà ïî ìåòîäó Hara
    Exact
    [17]
    Suffix
    . Ïåðåä ÏÝÒ-èññëåäîâàíèåì ïàöèåíòû ñ âå÷åðà íå äîëæíû áûëè åñòü, ðàçðåøàëîñü òîëüêî ïèòü âîäó è ïðèíèìàòü íåîáõîäèìûå ëåêàðñòâà. Îáñëåäîâàíèå ïðîâîäèëè ñ èñïîëüçîâàíèåì ECAT Exact HR+ PET camera (Siemens/CTI, Knoxville, TN, USA).

18
Schmid HP, McNeal JE, Stamey TA. Observations on the doubling time of prostate cancer. The use of serial prostatespecific antigen in patients with untreated disease as a measure of increasing cancer volume. Cancer 1993; 71: 20312040
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    Âðåìÿ óäâîåíèÿ ÏÑÀ ðàññ÷èòûâàëîñü ïî ôîðìóëå, ãäå ÷èñëèòåëü – íàòóðàëüíûé ëîãàðèôì 2 (0,693), çíàìåíàòåëü – λ. Êàê ïîêàçàíî íà ðèñ. 1, λ – ýòî óãîë îòíîøåíèÿ ëèíåéíîé ðåãðåññèè ëîãàðèôìîâ çíà÷åíèé ÏÑÀ êî âðåìåíè (â ìåñÿöàõ)
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    [4, 18]
    Suffix
    . Âû÷èñëåíèÿ ïðîâîäèëè ñ èñïîëüçîâàíèåì Memorial Sloan-Kettering Medical Center prostate cancer prediction tool (http:// www.mskcc.org/mskcc/html/10088.cfm). ROC-àíàëèç ïîëó÷åííûõ äàííûõ áûë ïðîèçâåäåí ñ èñïîëüçîâàíèåì ñòàòèñòè÷åñêîé ïðîãðàììû SPSS-16.

19
Connolly D, Black A, Murray LJ, Napolitano G, Gavin A, Keane PF. Methods of calculating prostate-specific antigen velocity. Eur Urol 2007; 52: 1044– 1051
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    Îäíàêî ïðè ðåöèäèâàõ ÐÏÆ ñêîðîñòü íàðàñòàíèÿ è âðåìÿ óäâîåíèÿ ÏÑÀ îêàçàëèñü êëèíè÷åñêè çíà÷èìûìè ïðîãíîñòè÷åñêèìè ôàêòîðàìè â îòíîøåíèè ðåöèäèâèðîâàíèÿ.  íàøåì èññëåäîâàíèè ìû èñïîëüçîâàëè ìîäåëè, êîòîðûå ïîêàçàëè ñâîþ âûñîêóþ òî÷íîñòü
    Exact
    [19]
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    . Íåðàçðåøåííîé íà äàííûé ìîìåíò ïðîáëåìîé, îïèñàííîé â ëèòåðàòóðå, ÿâëÿåòñÿ ðàçëè÷èå â óðîâíÿõ âûÿâëÿåìîñòè ðåöèäèâîâ ñ ïîìîùüþ 11C-õîëèí ÏÝÒ/ÊÒ ó áîëüíûõ ïîñëå ÐÏ è ÐÒ.  íàøåì èññëåäîâàíèè, òàê æå êàê è âî ìíîãèõ äðóãèõ, äîëæíû ó÷èòûâàòüñÿ îïðåäåë ̧ííûå îòëè÷èÿ ìåæäó ïàöèåíòàìè, êîòîðûì ïðîâîäèëîñü õèðóðãè÷åñêîå ëå÷åíèå, è òåìè, êîìó ïðîâîäèëàñü ÐÒ.

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Stamey TA, Kabalin JN, McNeal JE et al. Prostate specific antigen in the diagnosis and treatment of adenocarcinoma of the prostate. II. Radical prostatectomy treated patients. J Urol 1989; 141: 1076-1083
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    Ñîãëàñíî îäíîé èç ãèïîòåç, ïðè÷èíîé ðàçëè÷èÿ ÿâëÿåòñÿ îáú ̧ì îïóõîëè. Ïðè ðåöèäèâå ïîñëå ÐÏ îáú ̧ì îïóõîëè ìàë è âåðîÿòíîñòü îáíàðóæåíèÿ ðåöèäèâà ñ ïîìîùüþ ÏÝÒ/ÊÒ íèçêà. Ñâÿçü ìåæäó îáú ̧ìîì îïóõîëè è óðîâíåì ÏÑÀ â êðîâè èññëåäîâàëè T.A. Stamey è ñîàâò.
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    . Îíè îáíàðóæèëè çíà÷èòåëüíóþ êîððåëÿöèþ ìåæäó óðîâíåì ÏÑÀ è îáú ̧ìîì îïóõîëè (r=0,70). Ïî èõ äàííûì îáú ̧ì îïóõîëè â 1 ìë ñîîòâåòñòâîâàë óðîâíþ ÏÑÀ – 3,6 íã/ìë. Ýòî ìîæåò îáúÿñíÿòü ðàçëè÷èÿ â ðåçóëüòàòèâíîñòè îáíàðóæåíèÿ ðåöèäèâîâ ñ ïîìîùüþ Таблица 3 Данные ROC\bанализа у больных после радикальной простатэктомии (РП) и радиотерапии (РТ) ПоказателиПосле РППосле РТ AUC*SE**AUC*SE** П С А0,6460,0

21
Stamey TA, Johnstone IM, McNeal JE, Lu AY, Yemoto CM. Preoperative serum prostate specific antigen levels between 2 and 22 ng./ml. correlate poorly with post-radical prostatectomy cancer morphology: prostate specific antigen cure rates appear constant between 2 and 9 ng./ml. J Urol 2002; 167: 103-111
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    Расчет времени удвоения ПСА [4]. 11C-õîëèí ÏÝÒ/ÊÒ ó áîëüíûõ ñ óðîâíåì ÏÑÀ íèæå è âûøå 3 íã/ìë [13]. Îäíàêî íåäàâíèå èññëåäîâàíèÿ ïîñòàâèëè ïîä ñîìíåíèå íàëè÷èå êîððåëÿöèè ìåæäó îáú ̧ìîì îïóõîëè è óðîâíåì ÏÑÀ ó ïàöèåíòîâ, êîòîðûì ïðîâîäèëàñü ÐÏ ïî ïîâîäó ÐÏÆ íà ðàííèõ ñòàäèÿõ áîëåçíè
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    [21]
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    .  äîñòóïíîé ëèòåðàòóðå ñâåäåíèé î ñîîòíîøåíèè îáú ̧ìà îïóõîëè è óðîâíÿ ÏÑÀ ïðè ðåöèäèâå ÐÏÆ îáíàðóæèòü íå óäàëîñü.  íàøåì èññëåäîâàíèè åñòü è íåäîñòàòêè. Ïðè îáñëåäîâàíèè áîëüøèíñòâà ïàöèåíòîâ ÏÝÒ è ÊÒ ïðîâîäèëèñü îòäåëüíî, è ìû èñïîëüçîâàëè èõ «íàñëîåíèå», ÷òî ìîãëî ïðèâåñòè ê ñíèæåíèþ òî÷íîñòè âûÿâëåíèÿ ðåöèäèâîâ ïî ñðàâíåíèþ ñ ïîëíîöåííîé ÏÝÒ/ÊÒ-ñèñòåìîé âèçóàëèçàöèè.

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Jong IJ, Pruim J, Elsinga PH, Vaalburg W, Mensink HJ. Preoperative staging of pelvic lymph nodes in prostate cancer by 11C-choline PET. J Nucl Med 2003; 44: 331-335
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    Ïðè îáñëåäîâàíèè áîëüøèíñòâà ïàöèåíòîâ ÏÝÒ è ÊÒ ïðîâîäèëèñü îòäåëüíî, è ìû èñïîëüçîâàëè èõ «íàñëîåíèå», ÷òî ìîãëî ïðèâåñòè ê ñíèæåíèþ òî÷íîñòè âûÿâëåíèÿ ðåöèäèâîâ ïî ñðàâíåíèþ ñ ïîëíîöåííîé ÏÝÒ/ÊÒ-ñèñòåìîé âèçóàëèçàöèè. Ïðè îáñëåäîâàíèè ïàöèåíòîâ ñ ãèñòîëîãè÷åñêè ïîäòâåðæäåííûìè ìåòàñòàçàìè ëèìôàòè÷åñêèõ óçëîâ 11C-õîëèí ÏÝÒ âûÿâèëà ïîëîæèòåëüíûé ðåçóëüòàò ó 12 èç 15 (80%) áîëüíûõ
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    .  íåäàâíåì ïîäîáíîì èññëåäîâàíèè 11C-õîëèí ÏÝÒ/ÊÒ âûÿâèëà ðåöèäèâ ÐÏÆ ó 19 èç 21 (90%), ò.å. ó áîëüøåãî ÷èñëà ïàöèåíòîâ [23]. Äðóãèì íåäîñòàòêîì íàøåãî èññëåäîâàíèÿ áûëî òî, ÷òî ãèñòîëîãè÷åñêîå ïîäòâåðæäåíèå äèàãíîçà èìåëî ìåñòî òîëüêî ó 59% ïàöèåíòîâ.

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Scattoni V, Picchio M, Suardi N et al. Detection of lymphnode metastases with integrated [11C]choline PET/CT in patients with PSA failure after radical retropubic prostatectomy: results confirmed by open pelvic-retroperitoneal lymphadenectomy. Eur Urol 2007; 52: 423-429
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    Ïðè îáñëåäîâàíèè ïàöèåíòîâ ñ ãèñòîëîãè÷åñêè ïîäòâåðæäåííûìè ìåòàñòàçàìè ëèìôàòè÷åñêèõ óçëîâ 11C-õîëèí ÏÝÒ âûÿâèëà ïîëîæèòåëüíûé ðåçóëüòàò ó 12 èç 15 (80%) áîëüíûõ [22].  íåäàâíåì ïîäîáíîì èññëåäîâàíèè 11C-õîëèí ÏÝÒ/ÊÒ âûÿâèëà ðåöèäèâ ÐÏÆ ó 19 èç 21 (90%), ò.å. ó áîëüøåãî ÷èñëà ïàöèåíòîâ
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    . Äðóãèì íåäîñòàòêîì íàøåãî èññëåäîâàíèÿ áûëî òî, ÷òî ãèñòîëîãè÷åñêîå ïîäòâåðæäåíèå äèàãíîçà èìåëî ìåñòî òîëüêî ó 59% ïàöèåíòîâ. Ñ ïîäîáíîé ñèòóàöèåé ñòàëêèâàëèñü G. Giovacchini è ñîàâò. [8], êîãäà â 89% ñëó÷àåâ äèàãíîç ïîäòâåðæäàëè ñ ïîìîùüþ äîïîëíèòåëüíûõ ìåòîäîâ îáñëåäîâàíèÿ è äàííûõ êëèíè÷åñêîãî íàáëþäåíèÿ, è òîëüêî â 11% ñëó÷àåâ – ñ ïîìîùüþ ãèñòîëîãè÷åñêîãî èññëåäîâàíèÿ.