A.E. Tuleuov, U.Zh. Balpukov, N.V. Mironuk

Astana medical university

«Early diagnostics and prognosing of prostate cancer coarse».

According to the majority of specialists’ opinion, in the connection with the progressing incidence of prostate cancer at the end of ХХ and in the beginning of ХХI century, the disease became the global social and economic problem. Thus, for example, in 2005 prostate cancer was diagnosed at 679000 males (2 place in the structure of oncological incidences after lung cancer 11, 7% from the tumors).

Purpose of the research

To improve preliminary diagnostics of prostate cancer by indication in the blood serum of insulin-like growth factors binding proteins (IGFBP1, IGFBP 3).

Materials and methods. Dissertation is devoted to the comparative estimation of IGFBP1, IGFBP3, IGF-I, IGF-II production in blood serum of healthy people (20), cancer patients (52) and patients with benign prostate hyperplasia (23).

Initial (before treatment) level of IGFBP 1 in the blood serum of the general group of patients with prostate growth (prostate cancer and benign hyperplasia o prostate) in the average was 73, 3±8, 6 ng/ml and was not differentiated certainly from the content in the blood serum of practically healthy males 76,9 ± 5,9 ng/ml. Certain differences were not revealed in the indicators of IGFBP 1 between patients with prostate cancer and benign hyperplasia of prostate.

It was revealed that initial concentration of IGFBP1 in the blood serum certainly increased with age of patients with prostate cancer.

The content of IGFBP 1 in the blood serum at the patients with prostate cancer with the duration of anamnesis more than 1 year was certainly lower 63,0 ± 13,9 ng/ml than at the patients with benign hyperplasia (107,6 ± 45,5 ng/ml). Patients with prostate cancer which volume of prostate gland is more than 40 sм³ revealed certain decrease in the content of IGFBP 1 in the blood serum (58,9 ± 12,3 ng/ml) than at the patients with benign hyperplasia103,3 ± 32 ng/ml.

Certain low level 59,0 ± 19,9 ng/ml of IGFBP1 in the blood serum of patients with prostate cancer was revealed at the indicators of general prostate specific antigen in the blood serum lesser than 10 ng/ml comparatively to the patients with benign hyperplasia 89,2 ± 20,2 ng/ml . It was noticed uncertain decrease of the level of IGFBP 1 in the blood serum of patients with prostate cancer depending on spreading of the process and on the increase of degree of the differentiation of the tumor. Index of IGFBP1 was minimal at the patients of IV stage and was equal to 57,9 ± 19,3 ng/ml and at 8^th degree of differentiation of the tumor according to Glisson were 65,9 ± 49 ng/ml.

Identification at examined patients with indicated clinical pathologies of pancreas which is focused on the preoperative diagnostics level of IGFBP1 which is equal to 60 ng/ml allows excluding with high accuracy the benign nature of prostate growtn.

Correlation of IGF-II/ИФРСБ1 was minimal at the 1^st stage of the disease and enlarged with the progressing of the malignant tumor.It was maximum at the abandoned forms of the prostate cancer.

At patients of 1^st group the index of correlation IGF-II/ИФРСБ1 uncertainly increased with the growth of differentiation of prostate cancer according to Glisson. While revealing correlation IGF-II/ИФРСБ1 in the blood serum higher than 5,0 the physician should be oncologically careful and he should multifocal biopsy of prostate.

It was revealed decrease of concentration IGFBP3 in the blood serum of patients with prostate tumors 1952,4 ± 216,8 ng/ml comparatively to the practically healthy persons 3128,8 ± 195,2 ng/ml.

In case of anamnesis of less than 1 year level of IGFBP3 in the blood serum was certainly higher at patients with prostate cancer 2241,7 ± 479,6 ng/ml comparatively to the benign hyperplasia of prostate gland 1147,5 ± 462,2 ng/ml.

Concentration of IGFBP3 in the blood serum was minimal at patients with prostate cancer at 1^st stage 1520,2 ± 1103,9 ng/ml. Concentration of IGFBP3 in the blood serum was minimal at 4-5 stage of differentiation of tumors according to Glisson 1661,7 ± 449,6 ng/ml.

It was certain it’s higher level at patients with prostate cancer in comparison with benign hyperplasia. It was revealed control level of protein IGFBP3, which is equal to 1400 ng/ml (sensitivity 67,3% ± 12,6, representatives 60,9% ± 19,4).

Correlation of proteins IGF-I/ IGFBP3 may apply as additional test to total concentration prostate specific antigen in preoperative diagnostics of prostate growth especially among patients of 70 years old. Revealing correlation IGF-I/IGFBP3 in the blood serum of less than 0,045 it is necessary to carry out additional diagnostic procedures indicating prostate cancer.

On the basis of abovementioned we came to the following conclusions:

It was not revealed certain differences in IGFBP 3 indicators between practically healthy males, patients with cancer and benign hyperplasia of prostate gland. Analising the content of in IGFBP 3 it was revealed certain decrease of its concentration in the blood serum of patients with prostate growth 1952,4 ± 216,8 ng/ml in comparison with the practically healthy men 3128,8 ± 19,2 ng/ml (р<0,05).

The decrease of the level of in IGFBP 1 in the blood serum of patients with prostate cancer was noticed in the dependence with spreading of the process and in the increase of differentiation level of the tumor according to Glisson. The index of in IGFBP1 was minimal at patients of IV stage 57,9 ± 9,3 ng/ml and 8^th stage of differentiation of tumors according to Glisson 65,9 ± 4,9 ng/ml. Concentration of in IGFBP3 in the blood serum was minimal at patients with 1^st stage of prostate cancer 1520,2 ± 103,9 ng/ml, and also at 4-5^th stage differentiation of tumor according to Glisson 1661,7 ± 49,6 ng/ml.

Absolute indexes of protein of in IGFBP 1 and in IGFBP 3 did not have great diagnostic value, while their correlation with insulin-like factors of growth had. Correlation IGF-II/IGFBP1 in the blood serum was certainly higher at prostate cancer (6,0) comparatively to the patients with benign hyperplasia (4,1). At the same time correlation of IGF-I/IGFBP3 in the blood serum of patients with prostate cancer is certainly lower 0,041 ± 0,004 than at patients with benign hyperplasia 0,052 ± 0,008.

The index of IGFBP1 characterizes malignancy of prostate cancer and may be applied in the prediction of the disease course. Thus, concentration of IGFBP1 correlates with such unfavorable predicative features as abundance of prostate cancer, low level of tumor differentiation, high level of malignancy, presence of metastasizes. Level of IGFBP1 in blood serum less 60 ng/ml is evidences of spreading of tumor process and high malignancy of prostate tumor.

We believe that identification of initial level of proteins IGFBP1 and IGFBP3 in the blood serum, and their correlation IGF-I/IGFBP3 and IGF-II/IGFBP1 is adequate in the algorithm of diagnostics of prostate cancer. It allows optimizing timely diagnostics of prostate cancer.