Cancer Urology

Background. Active surveillance is a widely used treatment for clinically localized low-risk prostate cancer in the Western countries; however, its safety and efficacy in the Belarussian healthcare settings have not been established.

Aim. To evaluate the short-term outcomes of active surveillance in our cohort and to analyze predictive factors for reclassification.

Materials and methods. The study included 249 patients with verified clinically localized prostate cancer, a life expectancy of ≥10 years, and at least one surveillance biopsy. The primary endpoint was survival (time) to reclassification (increased differentiation group or increased clinical stage). Various predictive factors for reclassification were also analyzed.

Results. Median follow-up was 31.2 months (95 % confidence interval 28.2–34.1 months). Tumor reclassification occurred in 62 cases (24.9 %). Median time to reclassification was 65.2 months, and to treatment, 55 months. According to multivariate analysis, prostate-specific antigen density (p <0.001) and percentage of positive cores in biopsy (p = 0.006) were the most significant predictors of reclassification.

Conclusion. The method demonstrated acceptable safety and efficacy results; however, continued follow-up is necessary to determine long-term outcomes.

Background. Prostate cancer is one of the most common oncological diseases in men and remains an important problem of modern oncological urology. One of the approaches to management of patients with clinically localized prostate cancer and low or favorable intermediate risk is active surveillance. Currently, there is a risk of underestimating tumor aggressiveness. The scale of this risk is unknown, and the factors affecting its significance are not sufficiently understood.

Aim. To evaluate frequency and identification of prognostic factors of unfavorable pathomorphological signs through analysis of prostatectomy material from patients with clinically localized prostate cancer and low or favorable intermediate risk.

Materials and methods. The retrospective study included 353 patients with clinically localized prostate cancer and low or favorable intermediate oncological risk who underwent radical prostatectomy in our center in 2016–2020. Primary endpoints were presence and frequency of unfavorable pathomorphological signs, upgrade. Additionally, frequency of upgrade of ISUP GG (International Society of Urological Pathology Grade Group) was evaluated depending on a number of prognostic factors. To determine independent effect of these factors, multivariable logistic regression was used with development of prognostic models.

Results. Upgrade was reported in 35.4 % of patients. Evaluation of the factors associated with unfavorable pathomorphological signs showed that the following characteristics had statistical significance: ISUP GG per biopsy (p = 0.044), percentage of positive cores (p = 0.017), maximal tumor fraction in positive cores (p = 0.009). For predicting upgrade, 2 key factors were identified: maximal tumor fraction in positive cores (p = 0.033), tumor ISUP GG (p = 0.037). The proposed prognostic classifications confirmed their efficacy and reproducibility in this patient sample.

Conclusion. Data analysis allowed to identify significant factors increasing probability of upgrade: presence of ISUP GG 2 and maximal tumor percentage in positive biopsy cores above 15 %. The main predictors associated with disease stage increase were ISUP GG 2 per biopsy, percentage of positive cores above 50 % and maximal tumor fraction in a core above 15 %. If any 2 of the factors are present, active surveillance should be performed with great care and be accompanied by scrutinous control.

The objective of the study was to demonstrate the non-inferiority of low-intensity BCG therapy regimens (BCG – Bacillus Calmette–Guérin) compared with the classical Southwest Oncology Group (SWOG) regimen in patients with intermediate- and high-risk non-muscle-invasive bladder cancer (NMIBC) who underwent transurethral resection of the bladder tumor (TURBT).

Materials and methods. A prospective, interventional, four-arm, open-label, randomized phase II clinical trial with a non-inferiority design is being conducted. The main inclusion criteria are histologically verified intermediate- or high-risk NMIBC in patients aged ≥18 years who have undergone TURBT. Patients were randomized into four treatment groups at a 1:1:1:1 ratio to receive intravesical BCG vaccine therapy: experimental groups 1 (50 mg, 1 year), 2 (50 mg, 3 years), and 3 (100 mg, 1 year), and control group 4 (100 mg, 3 years). The primary endpoint is the 1-year rate of local NMIBC recurrence after TURBT. To confirm the non-inferiority of the studied regimens compared with standard treatment, enrollment of >315 patients is required so that the upper limit of the 99 % one-sided confidence interval (CI) for the hazard ratio (HR) of the 1-year local recurrence rate does not exceed 1.35.

Results. A second interim analysis was performed at a median follow-up of 16.7 (2.5–33.6) months. Data from 401 patients with a median age of 66.4 (31–95) years were included. According to the European Organization for Research and Treatment of Cancer (EORTC) risk classification, 93 (23.2 %) patients were classified as intermediate risk and 308 (76.8 %) as high risk. All patients received BCG therapy in the regimen corresponding to their randomization group (group 1 – 100 (24.9 %), group 2 – 92 (23.0 %), group 3 – 109 (27.2 %), group 4 – 100 (24.9 %)). The treatment groups were balanced with respect to the main characteristics. The 1-year local recurrence rate was 12.5 %. At a data maturity of 69.5 % by follow-up duration for the primary endpoint, per-protocol analysis demonstrated non-inferiority of the studied regimens in group 1 (HR 1.029; 99 % CI 0.916–1.156) and group 2 (HR 1.114; 99 % CI 0.850–1.125); the HR between groups 3 vs. 4 was 0.813 (99 % CI 0.349–1.893), in favor of the studied regimen.

Conclusion. Short-term results support continuation of the randomized phase II clinical trial until the final analysis of the primary endpoint.

Background. In 60–80 % of patients with seminomatous testicular germ cell tumours (STGCT) metastatic to the retroperitoneal lymph nodes (RPLN), residual retroperitoneal masses persist after first-line chemotherapy. The optimal management of such patients – surveillance or retroperitoneal lymph node dissection (RPLND) – remains a matter of debate.

Aim. To compare progression-free survival (PFS) and overall survival (OS) between surveillance and RPLND in patients with STGCT metastatic to RPLN with an incomplete response to induction chemotherapy.

Materials and methods. This retrospective single-centre study included patients with STGCT metastatic to RPLN who received first-line chemotherapy between 2001 and 2025; patients were either kept under surveillance or underwent RPLND. To compare the groups, propensity score matching (PSM) was performed to form a homogeneous subgroup. The primary endpoint was PFS; the secondary endpoint was OS.

Results. The analysis included 74 patients: 51 in the surveillance group and 23 in the RPLND group, of whom 5 patients with histologically confirmed seminoma but marker levels (alpha-fetoprotein ≥20 IU/mL and/or β-subunit of human chorionic gonadotropin >1000 mIU/mL) meeting IGCCCG (International Germ Cell Cancer Collaborative Group) criteria for a non-seminomatous tumour were excluded from the analysis; the main analysis therefore comprised 51 patients under surveillance and 18 who underwent RPLND. The groups were comparable for most baseline characteristics; distant metastases (M1) were significantly more common in the RPLND group (27.8 % vs 7.8 %; p = 0.045). RPLND achieved complete resection (R0) in 94.4 % of cases with a complication rate of 5.6 % (no complications ≥Clavien–Dindo IIIa); viable tumour or teratoma was found in 38.9 % of operated patients. PFS did not differ significantly between the groups: the proportion of progression-free patients was 88.9 % in the RPLND group and 96.1 % in the surveillance group (p = 0.277); median PFS was not reached. No difference was observed in the matched subgroup after PSM either (progression 1/8 vs 0/17; p = 0.29).

Conclusion. In this Russian cohort of STGCT patients with an incomplete response to induction chemotherapy, no significant differences in PFS or OS were found between patients managed with surveillance and those who underwent RPLND. In patients with a favourable prognosis and residual masses, surveillance appears to be a reasonable management strategy.

Metastasis of prostate cancer to the epididymis is exceptionally rare, with only 23 cases reported. This case highlights diagnostic challenges and underscores the role of advanced imaging in detecting atypical metastases.

Aim. To present a case of acinar adenocarcinoma metastatic to the left epididymis, analyzing pathogenesis, diagnostic approaches, and management strategies.

A 67-year-old male with prostate cancer (initial cT2cN0M0, Gleason 8) underwent laparoscopic radical prostatectomy with pelvic lymphadenectomy (21.09.2023). Histopathology revealed pT3bN1 (3/24 nodes), Gleason 9 (4 + 5), positive surgical margin (R1). Adjuvant radiotherapy (total dose 70.8 Gy) and androgen deprivation therapy (goserelin) were administered. Upon biochemical recurrence (prostate-specific antigen (PSA) >2 ng/mL), positron emission tomography combined with computed tomography, with prostate-specific membrane antigen (PSMA-PET/CT) detected lesions in the left epididymis, lung, and bones. Bilateral orchiectomy was performed. Histological examination included morphology and immunohistochemical study (PSA, PSMA, NKX3.1). PSMA-PET/CT showed intense uptake in the left epididymis (standardized uptake value maximum 12.7), left lung (6 mm nodule), and bones. Orchiectomy confirmed metastatic adenocarcinoma in the epididymis with vascular/perineural invasion, morphologically identical to primary prostate cancer. IHC: PSA (+++), PSMA (+++), PLAP (−), OCT3/4 (−), excluding germ cell tumor. HRR gene testing revealed no mutations. Enzalutamide (160 mg/day) was initiated due to progression.

Epididymal metastases from prostate cancer are anecdotal (0.01 %), requiring differentiation from primary testicular tumors. PSMA-PET/CT is pivotal for detecting atypical recurrences (sensitivity 85–92 % at PSA >0.5 ng/mL). Aggressive features (Gleason 9, R1, early recurrence) predict multifocal progression, including rare sites. Orchiectomy serves dual diagnostic and therapeutic purposes (androgen deprivation). Reporting such cases is crucial for optimizing management algorithms.

Birt–Hogg–Dubé syndrome (BHDS) is a rare autosomal dominant disorder caused by pathogenic mutations in the FLCN tumor suppressor gene. The classical triad includes cutaneous fibrofolliculomas, spontaneous pneumothorax, and multiple renal tumors. However, the disease exhibits variable expressivity; renal manifestations may be the first and only symptom in young patients, leading to diagnostic difficulties and risk of suboptimal treatment. In cases of isolated renal involvement, BHDS diagnosis is often delayed. Reports in the Russian literature remain scarce.

Aim. To present a clinical case of BHDS in a 35-year-old female patient presenting with bilateral multifocal renal tumors (oncocytoma and chromophobe renal cell carcinoma) and multiple pulmonary cysts, successfully managed with staged bilateral laparoscopic partial nephrectomy. This case illustrates a modern diagnostic algorithm, underlines the importance of multidisciplinary approach (radiology, morphology, genetics) and justifies the necessity of including BHDS in differential diagnosis of renal neoplasms in young patients.

Background. Penile cancer is a rare malignant tumor: its prevalence ranges from 0.1 to 5.9 cases per 100,000 men. This type of cancer is very often left out due to the rarely correctly diagnosed disease and the lack of awareness among the male population about the need to regularly prevent checkups with an urologist. The rates depend significantly on the region, but in less populated regions, morbidity and mortality are significantly lower than in large cities due to the lack of diagnostic measures and the low frequency of treatment in case of clinical symptoms.

Aim. To perform the population-level analysis of temporal trends in the incidence and mortality of penile cancer in the Russian Federation, as well as to evaluate the completeness and quality of case registration for this malignancy. Additionally, patterns of one-year incidence and mortality were examined using data from the population-based cancer registry of the Northwestern Federal District.

Materials and methods. Data were obtained from the International Agency for Research on Cancer, the population-based cancer registry of the Northwestern Federal District of the Russian Federation, and the N. N. Petrov National Medical Research Center of Oncology, Ministry of Health of the Russian Federation (Saint Petersburg). For detailed assessment of epidemiological characteristics, including one-year incidence and mortality among patients with penile cancer, the database of the Northwestern Federal District population-based cancer registry was analyzed. The overall study cohort comprised 2,728 registered cases of penile cancer.

Results and conclusion. From 2000 to 2023, both the absolute number of cases and the age-standardized incidence rate of penile cancer in the Russian Federation demonstrated an increasing trend, with the age-standardized incidence rate rising from 0.54 to 0.98 per 100,000 population. However, since 2019, a declining trend in the age-standardized incidence rate has been observed.

Prostate cancer remains one of the leading causes of cancer morbidity and mortality among men worldwide. Over the past decade, the approaches to systemic therapy of advanced prostate cancer have undergone fundamental changes. While androgen-deprivation therapy as monotherapy was previously considered the standard of care, the accumulated body of evidence now strongly supports the need for early treatment intensification using androgen signaling inhibitors and/or docetaxel, as well as their combinations. This strategy significantly improves disease control and extends patient survival. Among second-generation androgen receptor inhibitors, darolutamide holds a distinct position due to its unique chemical structure, which provides high selectivity, minimal blood–brain barrier penetration, and a favorable drug–drug interaction profile. The efficacy and safety of darolutamide have been confirmed in several large-scale international phase III trials encompassing various stages of the disease – from non-metastatic castration-resistant to metastatic hormone-sensitive prostate cancer – both in combination with androgen-deprivation therapy and as part of triplet therapy with docetaxel. However, no matter how robust the evidence from randomized registration trials may be, they cannot provide exhaustive answers to all questions encountered in routine clinical practice. Strict patient selection criteria, fixed treatment regimens, and predefined endpoints limit the generalizability of results to the broader patient population. The ARASAFE, ARASEC, and ARACOG studies, the results of which were presented at major international congresses in 2026, are designed to address these gaps. The aim of this review is to summarize and analyze the data from these studies, define their place, and elucidate their role in facilitating the transition toward a personalized model of systemic therapy selection for patients with advanced prostate cancer.