Prostate cancer

Prostate cancer

Did you diagnose: prostate cancer?

Speak you ask yourself: what to do now? A similar diagnosis is always dividing life on to and after. All emotional resources of the patient and its relatives are thrown on experiences and fear. But it is at this moment that it is necessary to change the vector For what on the vector What can be done.
Very often, patients feel infinitely lonely ways. But you must understand – you are not alone. We will help you cope with the disease and will go with you hand in hand through all the stages of your treatment.
We bring to your attention a brief, but very detailed review of the prostate cancer.
His highly qualified specialists of the Urological Department of MNII named after P.A. Herzen – branch of the FSBI NMITs Radiology of the Ministry of Health of Russia, edited by the head of the department of Nikolai Vorobyev.

This brochure contains information on the diagnosis and treatment of prostate cancer. It contains the main methods of treating this disease, including the latest developments of domestic and foreign scientists-oncologists.

Every year more than 38 thousand new cases of prostate cancer diseases are detected in Russia, which is particularly alarming, the disease is increasingly manifested in young men.

We want to help you defeat cancer!

Branches and branches where prostate cancer is treated

MNII them. P.A. Herzen – branch of the FGBU NMITs Radiology of the Ministry of Health of Russia.

Urology department
Head – K.M.N, Vorobyov Nikolay Vladimirovich
Tel.: +7 (495) 150-11-22

MRNTs them. A.F. Tsyba – branch of the FGBU NMITs of Radiology of the Ministry of Health of Russia.

Department of radiation and surgical treatment of urological diseases with a prostate cancer brachitarian group
Head – D.M., Professor Karyakin Oleg Borisovich
Tel.: +7 (484) 399-31-30

Urology and interventional radiology them. ON THE. Lopatkin – branch of the FGBU NMITs of Radiology of the Ministry of Health of Russia.

Oncological-urological department
Head of the Department – Ph.D. Kachmazov Alexander Alexandrovich
Tel.: +7 (499) 110 40 67

Introduction. Anatomy organ

Prostate gland (synonymous: prostate) – iron outdoor secretion, there are only men. The prostate gland is located below the bladder, in front of the rectum. Through it passes the initial part of the urethra. Blind of prostate glands are opened in the urethra (Fig. 1). Prostate functions control hormones, male sex hormone – testosterone has the greatest effect on the growth of prostate gland cells. Androgens are a common name for all male genital hormones. The liquid produced by the prostate gland is the main component of the seed fluid. This liquid is a feed medium for spermatozoa.Also, the prostate acts on the role of the valve – closes the output from the bladder during the erection.

Fig.1 of the prostate anatomy

What is a malignant prostate tumor?

Prostate cancer – This is a malignant tumor, developing from epithelial cells of the prostate glands.

The tumor can be located in one or both pieces of the gland, acquire a total distribution with invasion beyond the capsule of the gland, the involvement of seminal bubbles.

Prostate cancer is a relatively slow progressive disease. But with a long existence and absence of treatment, as well as other malignant tumors, it has the ability to increase and grow in the adjacent organs and structures, as well as to give extraction to the lymph nodes (regional metastases). The prostate tumor in the later stages can grow into the neck of the bladder, the rectum or the pelvis wall. Tumor cells can be transferred with blood flow to other organs (bones, lungs, liver, etc.) and give rise to new foci (distant metastases).

Prostate cancer statistics (epidemiology)

Over the past decade in the structure of the incidence of malignant neoplasms of the male population of Russia, the prostate cancer ranks second after lung cancer.

The incidence rate of the prostate cancer in Russia over the past 15 years from 2001 to 2015 increased 3.0 times from 19.01 to 57.22 cases per 100 thousand population.

In Russia in 2016, 38371 new cases of this pathology were noted, and the average annual incidence growth rate was 7.12%

Morphological Classification of Prostate Cancer

The most common morphological embodiment of the malignant prostate tumor is an acinar adenocarcinoma to 85-90% of cases. The degree of differentiation and aggressiveness of the prostate tumor is expressed in the morphological characteristics that are valued on the Gleason scale.

Gleason Score scale / amount

The gleason scale / sum is used to describe the malignancy of the tumor detected during the prostate biopsy. The higher the amount on the glues scale, the more aggressive / malignant tumor tissue. The amount of glemon points can only be determined in the study of the morphological material – the material of the thickogenic biopsy or postoperative material.
The glues scale is based on the degree of difference of cancer cells found in prostate tissue, from normal prostate cells. If cancer cells look like ordinary prostate cells, then the tumor receives 1 score. If the cancer cells differ as much as possible from normal, the tumor receives the maximum number of points – 5. Most often, estimates in 3 points and above are there in diagnoses.
The gleason amount includes estimates (points), the Gleason scale data (from 1 to 5 points) two largest or malignant tumors found in prostate tissues (prostate cancer usually affects several prostate areas).For example, the gleason amount equal to 7 points denotes that the two largest or malignant tumors obtained 3 and 4 points, respectively (3 + 4 = 7). There are three types of malignancy of prostate cancer:

• Tumors with glues equal to 6 points and less often called less malignant (Low-Grade Gleason Score).
• Tumors with the amount of gleason 7 points are called medium-malign (Intermediate Gleason Score).
• Tumors with Gleason's sum from 8 to 10 points (10 points – this is the maximum amount) is called strong-malignant (High-Grade Gleason Score).

Stages and symptoms of prostate cancer

As all malignant neoplasms, the development of prostate cancer 4 stages are distinguished:

• First stage The process corresponds to the prevalence of the tumor is not more than half of one stake of the gland.
• Second stage It is characterized by the presence of a localized prostate tumor (without the intake of the tumor behind the gland capsule), it can be amazed either one or both stakes of the gland.
• Third stage It is characterized by the presence of a local prostate tumor (the yield of the tumor behind the gland capsule).
• Fourth Stage It is always determined in the presence of regional (metastases in pelvic lymph nodes N1) or remote metastases (M1).

Prostate cancer classification

TNM classification

TNM classification (Tumour, Node, MetaStasis is a tumor, a lymphatic assembly, metastases) is an international classification of the development stages of malignant tumors.

T – Primary tumor:
T1-2 – the tumor does not go beyond the prostate capsule
T3-4 – The tumor germinals beyond the limits of the prostate gland capsule, can grow into adjacent organs (bladder, direct intestine)

N – lymphatic nodes:
N0 – no metastases in lymph nodes, N1 – the presence of metastases in one or more lymph nodes

M is a symbol denoting the presence or absence of remote metastases:
M0 – distant metastases are absent,
M1 – remote metastases in the bones or internal organs.

Clinical manifestations of prostate cancer

At the initial stages of the disease of the prostate cancer (RPG), there is no independent clinical manifestation. Clinical symptoms with a localized RLPG is most often related to a concomitant benign hyperplasia of the prostate fabric. Most often, patients with localized RPP have symptoms of infrawelicinal obstruction associated with a benign prostate gland hyperplasia.

For the topically common prostate cancer, the presence of symptoms of urinary tract obstruction, which is due to both a concomitant benign hyperplasia of the prostate gland and large volume of tumor. Under the germination of the tumor in the neck of the bladder, the urethra is possible the appearance of blood impurities in the urine, urinary incontinence.

An extensive tumor lesion of the neck of the bladder can lead to a block of mouth of the ureters, the development of renal failure. The spread of the tumor process on vascular-nerve bundles leads to the development of erectile dysfunction. The symptoms of the tumor germination or the compression of the wall of the rectum are the violation of the act of defecation, the blood admixture in the urine. The spread of the tumor on the muscles of the pelvic bottom can cause a feeling of discomfort when the seat, pain in the crotch. The massive tumor lesion of pelvic lymph nodes leads to lymphostase, an external genital feed, lower extremities.

Causes of prostate cancer and risk factors

Prostate cancer (RPG) is one of the most common oncological diseases in men. Around the world, the incidence and mortality from this pathology are steadily increasing. The question of the reason for the development of this pathology remains open, since the causes of the emergence of the RLPG were not fully studied. Nevertheless, some risk factors for the development of this disease are already allocated. The main, most studied risk factors for the development of prostate cancer are age, racial affiliation, as well as the presence of so-called prostate cancer. In addition, a number of studies show an effect on the incidence of prostate cancer and other factors, such as the hormonal status of the body, diet, sexual behavior, the factors of the external environment and genetic features. Currently, a huge number of factors that are directly or indirect can contribute to the occurrence of prostate cancer. However, the impact of many of these factors is not resistant and permanent, while the influence of other factors is not reliably proven to make any clear statements about their influence on the incidence of this pathology. Many studies focused on studying the role of diet, food, hormonal influences, as well as infection in the occurrence of prostate cancer.

Prostate cancer diagnosis

Finger rectal research

The finger rectal study is a routine method of examination of patients with suspected prostate cancer, one of the main methods of examination on a series with measuring the level of the PSA in serum. The advantages of the finger rectal research is accessibility, security and does not require economic costs. These method allows you to identify the tumors of the prostate gland localizing in the peripheral sections, if they are volume exceeds 0.2 ml.

Prostate-specific antigen (PSA)

For the first time, the prostate-specific antigen was isolated from seed fluid in 1979.At the same time, its presence in the tissue of the prostate gland was established. In 1980, a serological test was produced to determine the PSA in the blood. Since 1987, the PSA is widely used in the diagnosis of prostate cancer, the establishment of the process stage, assess the effectiveness of treatment. The widespread use in the clinical practice of determining the level of PSA has radically changed the structure of the incidence of prostate cancer worldwide. Currently, the measurement of the PSA level is a screening method for identifying prostate cancer.

The concentration of PSA in serum is not more than 2.5 – 4 ng / ml.
Increased PSA levels may be due to a number of reasons, among which are the most significant:

1. Prostate cancer;
2. Benign prostatic hyperplasia;
3. The presence of inflammation or infection in the prostate gland;
4. Prostate damage (ischemia or prostate infarction).

The mechanical impact on the passage of the prostate gland also leads to an increase in the level of PSA in the blood serum. Interventions such as the prostate biopsy, transurethral resection or the presence of an inflammatory process may cause a significant increase in the level of PSA and require at least 4-6 weeks to return the PSA to the initial level.
Thus, possessing organ-specificity, the PSA is not a tumor-specific marker, and therefore the interpretation of data on the content of total PSA in the blood serum patients should be carried out by a doctor with regard to the above factors. For a long time, the level of the PSA = 4.0 ng / ml was considered the upper limit of the norm. Given the relevance of the problem of identifying RPGs in the early stages based on the assessment of the PSA level, several large studies were carried out confirmed by the remaining significance of the PSA diagnosis in the screenshot of the prostate cancer and identifying new approaches to the threshold values ​​of the PSA.

Age (years)	Average value (ng / ml)	Medium limit (ng / ml)	Recommended limit (ng / ml)
40-49	0,7	0,5-1,1	0-2,5
50-59	1,0	0,6-1,4	0-3,0
60-69	1,4	0,9-3,0	0-4,0
70-79	2,0	0,9-3,2	0-5,5

Table 1. The value of the conditional norm of the total PSA, taking into account age

It is most difficult to interpret the increase in the level of PSA in the range from 2.5 to 10 ng / ml, called the gray zone, since the reasons for increasing the PSA, along with prostate cancer, is prostatate, benign prostate gland hyperplasia, etc.
Along with the recommended threshold value of the PSA level, the age values ​​of the normal level of PSA were developed. Based on the analysis of the results of the survey of a large number of patients of various age groups, a table of dependence of the level of PSA from age is compiled. This approach is considered more accurate than the use of a certain threshold of the PSA level, since the PSA indicators in young patients are lower, and the elderly is higher. The use of PSA data, taking into account the age of patients, contributes to an increase in the sensitivity and specificity of the test, and also helps to avoid unnecessary biopsies.However, the use of age-related thresholds also does not have an unequivocal assessment.

Ultrasound examination of prostate cancer

In the case of the detection of an increased level of PSA and Nalizia, suspicion of the presence of an RPG with a finger rectal study, an ultrasound study (ultrasound) of a small pelvis is carried out, as well as transrekatel ultrasound. Culisers is an ultrasound study of the prostate performed using a special high-frequency ultrasonic sensor of a special design through the patient's rectory. In this case, the ultrasonic sensor is in close proximity to the prostate and separated from it only by the wall of the rectum. The main advantage of the corpus is the possibility of obtaining a full and very accurate image of prostate, various departments (zones), and, consequently, the pathological processes of this organ. Truzi allows you to consider detail seed bubbles. Casuals are most accurate when determining the volume of prostate and in the presence of appropriate equipment has a high resolution.

Biopsy Prostati

Prostate biopsy is performed in order to histological diagnosis of cancer and the formulation of the final diagnosis. It also allows you to establish the degree of tumor aggressiveness and the stage of the disease (its prevalence). The results of the biopsy of the prostate are an essential factor determining the patient's treatment tactics, as well as the disease forecast.
The biopsy of the prostate gland and histological research (the study of prostate tissue) is the only way to form a diagnosis of prostate cancer.

Magnetic resonance tomography of prostate cancer

Magnetic resonance imaging (MRI) is a method for studying internal organs and tissues using electromagnetic waves in a constant magnetic field of high voltage. MRI is a clarifying method of examination. MRI allows you to better detect the proliferation of the tumor behind the prostate gland capsule and the adjacent organs, an increase in lymph nodes (which may indicate the presence of metastases or the presence of an inflammatory process).

Radionuclide study of skeleton

Osteocintigraphy, or skeletal scintigraphy – a radionuclide diagnostic method based on the introduction of a special preparation into the body and subsequent registration of its distribution and accumulation in the skeleton using gamma-radiation isotope included in the preparation. Registration of the distribution of the radiopharmaceutical preparation is carried out using a gamma chamber. This method allows you to determine whether the tumor has spread into the bone. In the case of metastases in the bones, the drug selectively accumulates in them, which is determined during the study.Dose of irradiation during osteocintigraphy is very low, does not harm health.

Treatment of prostate cancer

Treatment of patients with prostate cancer largely depends on the stage and prevalence of the tumor process at the time of diagnosis. The main versions of the treatment of localized forms of tumor without remote metastases are surgical treatment and radiation therapy in combination with hormone therapy. In the case of remote metastases, medicinal systemic therapy is carried out. Below we present information about the various types of treatment of prostate cancer.

Surgery

Surgical treatment is a radical prostatectomy, which is to remove the prostate gland with seed bubbles and the surrounding prostate by the fiber to ensure complete removal of the tumor. Often, this operation is accompanied by the removal of pelvic lymph nodes, since the lymph nodes are the first barrier on the path of propagation of tumor cells. This operation is aimed at eliminating the malignant process while maintaining the urine retention function and, if possible, potency.

Radical prostatectomy is performed in the classic version of the open method and minimally invasive laparoscopic methods. Currently, methods of robot -sted (robotic) surgical treatment on the robot da Vinci are also applied.

Radiation therapy

Radiation therapy is methods of treatment using ionizing radiation. Rauchery therapy in the treatment of prostate cancer is divided into remote and intractaneous (brachytherapy).
Remote radiation therapy (DLT) – the radiation source is located at a certain distance from the patient, with remote effects between the focus of the impact and the source of radiation, healthy fabrics may lie. What they are more, the more difficult to deliver the necessary radiation dose to the hearth, and the more side effects of therapy. Intranate radiation therapy (brachitherapy) – radiation sources, the so-called grains using special tools are introduced directly into the tissue of the prostate gland.
In some cases, a combination of brachytherapy with DLT is used to improve the effectiveness of antitumor treatment. With prostate cancer, radiation therapy ensures the same lifespan, as well as a surgical operation. The quality of life after radiation therapy is at least no worse than after the surgical treatment method. In our center, the choice of treatment tactics is accepted on a consultation with the participation of a surgeon-oncologist and a radiotherapist and chemotherapist. A prerequisite is the consent of the patient based on full informing about the diagnosis, methods of treatment and possible complications.

Focal therapy methods

Currently, cryosurgical destruction of the prostate gland, the use of high-intensity focused ultrasound and photodynamic therapy (PDT) are used as alternative experimental methods for the treatment of localized prostate cancer. It must be remembered that the above methods are used only if cancer is detected at an early stage.

Hormone therapy for prostate cancer

Sex hormones – androgens, regulate a number of physiological processes in the male body, including the growth and functioning of the prostate gland. At the same time, they also stimulate the growth of tumor cells in prostate cancer. The goal of hormone therapy is to stop the production of androgens or block their action, which can significantly slow down the development of the malignant process. There are different modes of hormonal treatment, they are selected together with you by an oncologist, based on the stage of cancer detected, the possibilities of radical treatment, the course of the disease, the risk of progression and other factors.
Hormonal treatment may be prescribed to patients who have recurrence of prostate cancer after radiation therapy or surgery – radical prostatectomy. In addition, given that in many men hormonal treatment is effective for many years, this type of therapy may be indicated as a primary treatment in older people who have various comorbidities and are therefore at high risk of other aggressive treatments. Also, hormone therapy can be recommended for those patients who, for various reasons, refuse surgery or radiation therapy.
To monitor the effectiveness of hormonal treatment, the determination of the level of prostate-specific antigen (PSA) in the blood is used. The best option is to reduce the PSA level to 0.1 ng / ml 1.5–2 months after the start of treatment, although a value of no more than 0.5 ng / ml is very favorable for the patient. The effectiveness of hormone therapy largely depends on the initial value of PSA, the degree of malignancy of the tumor and the presence of metastases.

What is an orchitectomy?

An orchidectomy (or surgical castration) is the removal of the testicles by surgery, the purpose of which is to lower testosterone levels in the body to eliminate its effect on the prostate tumor. The operation is usually performed under local or intravenous anesthesia. In this case, the testicles are removed through one incision 3-4 cm long in the region of the scrotum root, or through two similar incisions located on the sides of the scrotum. With a visual examination of the scrotum a month after the operation, it is almost impossible to determine that the testicles have been removed.
The advantages of this type of hormonal therapy include a fairly rapid and irreversible decrease in testosterone levels, and the disadvantages are possible complications of the operation – hematoma (hemorrhage) of the scrotum and wound infection.In addition, many men refuse to have their testicles removed for emotional reasons.

What is Hormone Therapy by Injection?

When conducting hormone therapy by injection (shots), patients are given drugs called LHRH analogues (analogues of pituitary hormones – an endocrine gland located in the brain). 3–4 weeks after the administration of drugs of this group, the testosterone content in the blood decreases to a minimum level similar to that after orchidectomy, i.e. There is a so-called drug castration. In this case, there is no need to remove the testicles, and the operation remains a backup method of treatment, which can be used in the future if side effects of hormonal treatment appear or the patient refuses to continue it. In Russia, the most famous drugs of this group are Diferelin, Lucrin, Decapeptil, Suprefact, Prostap, and Zoladex, which is produced in a ready-to-use syringe and is injected under the skin of the abdomen monthly or once once every 3 months – depending on the dose (3.6 mg or 10.8 mg).

What is maximal androgen blockade?

A small amount (about 5%) of male sex hormones (androgens) is produced in the adrenal glands – endocrine glands located in the region of the upper poles of both kidneys. It is believed that during hormone therapy, in addition to injections of LHRH analogues (for example, Zoladex) or removal of the testicles, it is also necessary to take drugs – antiandrogens.
Antiandrogens block the ability of tumor cells to interact with sex hormones, causing, together with injectable drugs, an effect called maximum androgen blockade. According to a large number of studies, the effectiveness of maximum androgen blockade is higher than orchidectomy or isolated therapy by injection.
Among the antiandrogenic drugs in Russia, the most commonly used are Flucin, Anandron, Androkur and Casodex (bicalutamide), produced in the form of 50 mg tablets to be taken once a day, which is quite convenient for patients.

What are the possible side effects of hormone treatment?

Undesirable effects of hormone therapy include sensations of hot flashes, decreased libido and potency, swelling and soreness of the mammary glands, diarrhea, changes in liver function, etc. It must be emphasized that most of these side effects of hormonal drugs are relatively rare and rarely require discontinuation of treatment.

What is antiandrogen monotherapy?

Monotherapy with antiandrogens is indicated in patients with locally advanced non-metastatic prostate cancer as an alternative to medical or surgical castration. Casodex 150 mg per day is used for this type of treatment. The use of Casodex in this dosage provides patients with a better quality of life compared to orchidectomy.Many men preserve the sexual attraction and the ability to emerge the erection. An undesirable effect of this therapy is an increase in size (gynecomastics) and soreness of breast glands.

What is intermittent hormonal therapy?

Under the term intermittent (intermittent) therapy understand the cessation of hormonal treatment, when the PSA level decreases to the minimum value. Treatment renew when there is an increase in the level of PSA. Such a diagram of treatment allows to reduce its cost and minimize possible side effects. It should be noted that at present there is no sufficient amount of information about how intermittent therapy is effective and, most importantly, safe in terms of progression of prostate cancer. That is why this technique is considered to be experimental yet.

Why is hormonal treatment appointed before surgery or radiation therapy?

Acceptance of hormonal drugs for several months to operational treatment or irradiation of prostate (neoadjuvant therapy) allows to reduce the prostate gland in the amount and, thus, facilitate the course of the operation or increase the efficiency of radiation treatment methods. The disadvantage of this type of therapy consider the risk of negative manifestations of hormonal treatment – for example, erectile dysfunction or tides, which could be avoided with immediate execution of the operation. The study of this technique also continues.

Chemotherapy for prostate cancer

Chemotherapy – This is the use of one anti-cancer drug or their combination. It is prescribed in the case of a recurrence or prostate cancer of the late stage, which does not respond to hormonal treatment, but it is not used in the treatment of early stages of the disease. Chemotherapy is prescribed treatment cycles, followed by a period of recovery. All treatment usually lasts 3 – 6 months, depending on the type of chemotherapeutic drugs used.

What are the side effects?

Chemotherapy kills not only cancer cells, it and healthy cells of the body, such as the membranes of the mouth, the lunch of the gastrointestinal tract, the hair follicles and the bone marrow. As a result, the side effects of chemotherapy depends on the number of damaged cells. Specific side effects that can be dependent on the type and number of drugs, from the duration of the reception. The most common temporal side effects of chemotherapy include:

• Nausea and vomiting
• Loss of appetite
• Hair loss
• Defeating mucous membranes
• Diarrhea
• Infertility

To other side effects associated with the impact of chemotherapy for the bone marrow include an increased risk of infection (due to low levels of leukocytes), bleeding or bruising from the slightest damage (due to the low level of blood platelets) and fatigue caused by anemia ( For low levels of erythrocytes in the blood).Side effects of chemotherapy will disappear when treatment stops.

Using unique prostate cancer techniques

In the MNII them. P.A. Herzen has developed a protocol of combined treatment of prostate cancer patients with single metastases in pelvic or bones lymph nodes. In the event of the identification of the above metastatic foci at the time of the diagnosis of prostate cancer, the patient is carried out at the first stage of hormonal therapy in combination with 6 courses of chemotherapy (preparation of profacetexel). At the second stage, surgical removal of the prostate gland and lymph nodes of the pelvis and the retroperitoneal space are performed. If necessary, in the postoperative period, radiation therapy is carried out on the foci of bones. It is noted that this therapeutic approach allows to increase the time of faithful therapy, increase the timing without a relapse, and, possibly, the life expectancy of patients with this difficult group.

Features of rehabilitation after the treatment of prostate cancer

Rehabilitation after surgical treatment is carried out as a rule in several stages. In the early postoperative period, the patient is activated, sits down, gets up, starts walking after 12 hours after the operation. Meals also begins in the first day of the postoperative period. During surgery, surgeons are set to 1 or 2 drainage into the cavity of the small pelvis, the urethral catheter is installed in the uretral cavity to control the diurea and the adequate healing of the anastomosis between the bladder and the urethra. The urethral catheter is removed, as a rule, for 7-8 days after the operation. After 7-10 days after surgery, the patient is discharged in a satisfactory condition.
In the postoperative period, it is necessary to use a bandage that is required to wear 1-1.5 months. At this time it is recommended to avoid excessive physical exertion.

Forecast of the disease

The forecast of the disease primarily depends on the timeliness of the diagnosis of the disease, as well as on the characteristics of the tumor and the factors of the forecast (stage of the tumor process, the level of the PSA, the morphological characteristics of the tumor during biopsy). Prostate cancer by the number of deaths ranks third after lung cancer and stomach cancer. Early detection of tumor and proper treatment plays fundamentally important. In the event of a diagnosis of 1-2 stages, as well as at 3 stages in the case of the correctly selected treatment (surgical treatment or radiation therapy in combination with hormone therapy), it is possible to complete cancer. In the case of establishing 4 stages of the disease using drug treatment, you can achieve a resistant remission.

Branches and branches in which prostate cancer is treated

FSBI NMITs Radiology of the Ministry of Health of Russia has all the necessary technologies of radiation, chemotherapeutic and surgical treatment, including extended and combined operations.All this allows you to perform the necessary steps of treatment within the same Center, which is extremely convenient for patients.

1. The MNII Branch of MNII named P.A. Herzen – Branch of the FSBI NMITs Radiology Ministry of Health of Russia
Head of the Department – Ph.D. Vorobyov Nikolai Vladimirovich

Tel.: +7 (495) 150-11-22

2. Relationship of the radiation and surgical treatment of urological diseases with a group of brachypics of prostate cancer of the IRNC named after A.F. Tsyba – branch of the FGBU NMITs Radiology Ministry of Health of Russia G. Obninsk, Kaluga region
Head of the Department – D.M., Professor Karyakin Oleg Borisovich

Tel.: +7 (484) 399-31-30

3. Oncological and urological branch of urology and interventional radiology. ON THE. Lopatkin – branch of the FGBU NMITs of Radiology Ministry of Health of Russia
Head of the Department – Ph.D. Kachmazov Alexander Alexandrovich