Terragnostics And Targeted Alpha Therapy: When "technologies Of The Future" Will Come To Russia

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Terragnostics And Targeted Alpha Therapy: When "technologies Of The Future" Will Come To Russia
Terragnostics And Targeted Alpha Therapy: When "technologies Of The Future" Will Come To Russia

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Terragnostics and targeted alpha therapy: when "technologies of the future" will come to Russia

Prostate cancer is a malignant tumor of the genitourinary system in men, the prevalence of which has become epidemic in recent years. Innovative methods for the diagnosis and treatment of prostate cancer, as well as the problems of their availability, became the central themes of the VII Moscow Urological School, which brought together specialists not only from the capital, but also from all over the country.

Terragnostics and targeted alpha therapy: when "technologies of the future" will come to Russia
Terragnostics and targeted alpha therapy: when "technologies of the future" will come to Russia

Cancer cells. Photo: National Institutes of Health / Flickr /

Prostate cancer (PC) is a malignant tumor of the genitourinary system in men, the prevalence of which has become epidemic in recent years. Innovative methods for the diagnosis and treatment of prostate cancer, as well as the problems of their availability, became the central themes of the VII Moscow Urological School, which brought together specialists not only from the capital, but also from all over the country.

Checked or not checked

In the structure of cancer incidence in Russia, prostate cancer is in second place after lung cancer and in third place in the structure of mortality. In most cases, the disease is detected at 50-70 years. Prostate cancer is a multifactorial disease, among the risk factors: aggravated heredity, in which one can get sick after 40 years, as well as bad habits, work in hazardous industries, unhealthy diet, physical inactivity, high blood pressure and blood sugar, poor ecology. And, therefore, not a single man is immune from this misfortune.

Meanwhile, in recent years, the axiom of early cancer diagnosis - screening based on the determination of the level of prostate-specific antigen (PSA) in blood serum - has been questioned. The fact is that this study gives many false-positive results, on the basis of which unnecessary biopsies and even surgeries were made to men, and in some countries there were attempts to abandon this method. However, the results were deplorable - during the absence of screening, the incidence of severe forms of cancer increased.

There were also suggestions not to treat, but simply to leave men with small and non-aggressive tumors under supervision. "About five years ago, a study appeared that showed that some patients really do not need therapy," said the chief urologist of the Ministry of Health and the city of Moscow, head of the urology clinic of the GKB im. Spasokukotsky, Corresponding Member of the Russian Academy of Sciences Dmitry Pushkar. - But such patients are only 2-3%. However, our people, “having heard the ringing,” decided that cancer could not be cured. That is why we have so many patients with advanced stages of the disease. " Russian men over 50 years of age donate blood to test the PSA level as part of a clinical examination. And in no case should this opportunity be neglected, experts say.

Terragnostics

In the modern world, prostate cancer can be treated quite successfully, but in some men the disease progresses and can be life threatening. Up to 20% of all cases of prostate cancer are castration-resistant prostate cancer (CRPC) - an advanced form of tumor that is resistant to castration therapy. Approximately 90% of CRPC patients develop bone metastases, which become one of the leading causes of death. The problem of CRPC therapy is very relevant for Russian urological oncology - quite often patients come to the doctor with advanced forms of cancer, Pushkar notes.

According to him, with prostate cancer there are micrometastases in the liver, bones, lymph nodes, which doctors cannot find, although they know that they are. “Until recently, there were no diagnostic methods that could detect cancer cells 'scattered' throughout the body. But now special radionucleide research methods have appeared - charged alpha particles are detected. Moreover, you can make therapeutic charges that deliver drugs directly to diseased cells and help kill them. Such targeted therapy allows you to fight not only with identified, but also with hidden pathological foci. Even a new definition has appeared - teragnostics, which includes both therapy and diagnostics,”said the country's chief urologist.

Radionuclide therapy

In the past 15 years, significant progress has been made in the treatment of metastatic CRPC. A number of drugs for systemic therapy have appeared that have made it possible to increase life expectancy: hormone therapy, cytotoxic chemotherapy, and radionuclide therapy. These methods are not mutually exclusive; on the contrary, the sequential use of as many drugs with different mechanisms of action as possible allows you to achieve the best result.

Radionuclide therapy is a method of treating oncological diseases, allowing you to influence the foci of the disease from the inside. That is, the radiation exposure is carried out not due to external radiation, as in traditional external radiation therapy, but by injecting directly into the patient's body a radiopharmaceutical preparation containing a therapeutic radionuclide. In this case, the foci of the disease are exposed to targeted action from the inside, with minimal damage to healthy tissues. In Russia, radiopharmaceuticals are used based on strontium and samarium isotopes, which are beta emitters. However, this method has a significant disadvantage: due to the relatively long path of beta particles in tissues, the use of these isotopes has a negative effect on the bone marrow.

Targeted alpha therapy

Research on the use of other radiopharmaceuticals for the treatment of patients with bone metastases is under way worldwide. Recently in Russia, alpha emitters based on the isotope of radium have been used to treat such patients. This state-of-the-art method of radionuclide therapy is called targeted alpha therapy. Targeted alpha therapy allows you to target the tumor process, suppressing not only identified, but also hidden pathological foci.

Alpha emitters are injected into the patient's body by a conventional intravenous injection. The isotope of radium, due to its chemical similarity with calcium, is actively incorporated into bone metastases and, acting on tumor cells and its microenvironment, provides an antitumor effect. This allows not only to reduce pain, but also to suppress tumor growth. “Unlike beta emitters of the previous generation, targeted alpha therapy has a higher selectivity of action, with minimal damage to hematopoietic cells,” explained the head. Department of radiosurgical treatment with open radionuclides Tsyba (branch of the National Medical Research Center of Radiology of the Ministry of Health of Russia), MD Valery Krylov. "And the treatment itself can be performed on an outpatient basis."

Today this technology is available in more than 50 countries around the world and has already proven to increase patient survival. Unfortunately, in Russia, the coverage of targeted alpha therapy is minimal - less than 1% of patients, said Pushkar. But the professional community really hopes for its more active distribution.

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