Cancer UrologyCancer UrologyОнкоурология1726-97761996-1812Publishing House ABV Press188210.17650/1726-9776-2025-21-3-201-209REVIEWSОБЗОРЫReview ArticleProstate cancer with regional lymph node involvement: Is there a universal solution?Рак предстательной железы с поражением регионарных лимфатических узлов: есть ли универсальное решение?https://orcid.org/0000-0001-7754-6624VolkovaM. I.ВолковаМ. И.
Russian Federation
alakelibrahim1@gmail.comhttps://orcid.org/0000-0002-2855-5767Al-AkelI. S.Аль-АкелИ. С.
Russian Federation
alakelibrahim1@gmail.comOncology Center No. 1, Moscow City Hospital named after S. S. Yudin, Moscow Healthcare DepartmentОнкологический центр № 1 ГБУЗ г. Москвы «Городская клиническая больница им. С. С. Юдина Департамента здравоохранения г. Москвы»Russian Medical Academy of Continuing Professional Education, Ministry of Health of RussiaФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России181220252132012092611202423072025Copyright ©; 2025, Volkova M.I., Al-Akel I.S.Copyright ©; 2025, Волкова М.И., Аль-Акел И.С.2025Volkova M.I., Al-Akel I.S.Волкова М.И., Аль-Акел И.С.https://creativecommons.org/licenses/by/4.0https://oncourology.eco-vector.com/oncur/article/view/1882

Population of the patients with prostate cancer N1M0 is heterogenous, and their treatment requires the use of risk-adapted approach.

In case of clinically positive lymph nodes (cN1):

choice option: external beam radiation therapy (EBRT) with long-term adjuvant androgen deprivation therapy (ADT) (36 months) and abiraterone with prednisolone (24 months);

alternative: radical prostatectomy (in case of 1–2 enlarged regional lymph nodes and ISUP (International Society of Urological Pathology) grade 1–3) with possible subsequent prescription of ADT with or without EBRT depending on the presence of risk factors;

in case of short life expectancy: immediate ADT in combination with abiraterone acetate and prednisolone or delayed ADT (depending on the presence of symptoms and expected duration of survival).

In cases of histologically verified metastases in the regional lymph nodes (pN1):

choice option: immediate constant lifetime adjuvant ADT;

alternative if postoperative prostate-specific antigen level <0.1 ng/mL or <3 positive lymph nodes: dynamic observation;

alternative in the presence of risk factors (category pT ≥T3b, Gleason score 9–10, R1) and ≥3 positive lymph nodes: adjuvant EBRT and ADT.

Development of the optimal risk-adapted approach requires well-planned randomized clinical trials with adequate stratification and endpoints using high-fidelity diagnostic techniques, modern EBRT methods and new antitumor drugs.

Популяция пациентов с раком предстательной железы N1М0 разнородна, и их лечение требует применения риск-адаптированного подхода.

При клинически позитивных лимфатических узлах (cN1):

опция выбора – дистанционная лучевая терапия (ДЛТ) с длительной адъювантной андрогендепривационной терапией (АДТ) (36 мес) и абиратерона ацетатом с преднизолоном (24 мес);

альтернатива – радикальная простатэктомия (при 1–2 увеличенных регионарных лимфатических узлах и грейде ISUP (International Society of Urological Pathology, Международное общество урологической патологии) 1–3) c возможным последующим назначением АДТ с ДЛТ или без нее в зависимости от наличия факторов риска;

при малой ожидаемой продолжительности жизни – немедленная АДТ в комбинации с абиратерона ацетатом и преднизолоном или отсроченная АДТ (в зависимости от наличия симптомов и сроков ожидаемого дожития).

При гистологически верифицированных метастазах в регионарных лимфатических узлах (pN1):

опция выбора – немедленная постоянная пожизненная адъювантная АДТ;

альтернатива при послеоперационном уровне простатического специфического антигена <0,1 нг/мл и <3 позитивных лимфатических узлах – динамическое наблюдение;

альтернатива при наличии факторов риска (категория pT ≥T3b, сумма баллов по шкале Глисона 9–10, R1) и ≥3 позитивных лимфатических узлах – адъювантная ДЛТ и АДТ.

Для разработки оптимального риск-адаптированного подхода необходимы хорошо спланированные по факторам стратификации и конечным точкам рандомизированные клинические исследования с использованием высокоточных методов диагностики, современных методик ДЛТ и новых противоопухолевых препаратов.

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