Aim. To evaluate advisability and safety of prostate biopsy in men aged ≥75 years with asymptomatic prostate cancer (PCa).

Materials and methods. The retrospective study included data of 206 patients aged ≥75 years with asymptomatic verified PCa. Median age was 83.0 (76.0–97.0) years. Indications for biopsy were increased prostate-specific antigen (PSA) level ≥4 ng/mL (188 (91.3 %)), palpable tumor of the prostate (8 (3.9 %)) or lesions identified using magnetic resonance imaging (MRI) and suspected for PCa (10 (4.8 %)). Median baseline PSA level was 11.9 (1.8–103.0) ng/mL. All patients underwent prostate biopsy.

Results. Complications of prostate biopsy were registered in 3 (1.5 %) of 206 patients. Adenocarcinoma of the prostate was verified in all cases (ISUP (International Society of Urological Pathology) grade 4–5 in 50 (24.3 %) samples). сТ3–4 category was diagnosed in 49 (23.8 %), сN1 – in 12 (5.8 %), сМ0 – in 206 (100 %) cases. The groups of intermediate unfavorable, high and very high risks included 133 (64.6 %) patients. Patients aged ≥80 years compared to patients aged 75–79 years demonstrated significantly increased rates of ISUP grade 4–5 adenocarcinomas (26.8 % vs.14.3 %), Т3–4 categories (26.8 % vs.11.9 %), and PCa of intermediate unfavorable, high and very high risks (68.3 % vs. 50/0 %) (p <0.05 for all). Frequency of detection of PCa of intermediate unfavorable, high and very high risks was significantly higher for PSA ≥10 ng/mL (p <0.0001) and was 100 % for MRI-detected lesions of the prostate PI-RADS 5 (Prostate Imaging Reporting and Data System). In 15 (7.3 %) cases, delayed treatment was administered, in 92 (44.6 %) cases – radical treatment, in 99 (48.1 %) – immediate drug treatment. Median follow-up was 38.6 (1.4–234.2) months, 17 (8.3 %) of 206 patients died including 4 (1.9 %) patients due to PCa. No differences in survival were observed in the treatment groups.

Conclusion. Prostate biopsy in men aged ≥75 years is associated with low complication rate. The frequency of detection of aggressive PCa forms in men aged ≥75 years is high and increases with age. Probability of detection of aggressive PCa significantly increased for baseline PSA ≥10 ng/mL and MRI-visualized prostate lesions PI-RADS 5.

Aim. To evaluate the incidence of various viruses in prostate tissue in benign prostatic hyperplasia (BPH) and prostate cancer (PCa).

Materials and methods. The study included 145 patients who were operated on for BPH (n = 79) or PCa (n = 66) in the period between 2019 and 2023. Real-time polymerase chain reaction was performed in the obtained samples of surgical material to determine the presence of human papillomavirus (HPV), herpes simplex viruses type 1 and 2, cytomegalovirus (CMV), Epstein–Barr virus (EBV), herpes virus type 6 (HHV-6).

Results. Mean age of patients was 68.2 years. Viruses in prostate tissue were found in 40.7 % of patients in the total cohort: in 35.4 % of patients with BPH and in 47.0 % of patients with PCa (p = 0.159). The most common virus detected in the total cohort of patients was EBV which was found in 18.6 % of patients: in 16.5 % of patients with BPH and in 21.2 % of patients with PCa (p = 0.464). The second most common was HHV-6 (9.0 % of patients of the total cohort: 19.7 % of patients with PCa and in 0 % with BPH, p <0.001), and the third was CMV (7.6 % of patients: 2.5 % of patients with BPH and 13.6 % of patients with PCa, p = 0.027). When combining all HPV types, the prevalence of HPV was 10.3 %, but individual subtypes were found in isolated cases and their incidence in the total cohort did not exceed 2.1 %. The incidence of HPV (all types) was 16.5 % in patients with BPH and 3.0 % in patients with PCa (p = 0.018).

Conclusion. In patients with prostate diseases, almost half of the cases have viral infection localized in the prostate tissue. CMV and HHV-6 are the most common in patients with PCa. The latter was not found in patients with BPH. EBV is equally represented among patients with BPH and PCa.

Aim. To evaluate the immediate results of perineal implantation of a biodegradable spacer based on stabilized hyaluronic acid (SНA) of non-animal origin as a way to optimize radiation treatment of prostate cancer.

Materials and methods. The study included 48 patients with verified low and intermediate risk prostate cancer per NCCN (National Comprehensive Cancer Network) who received five-fraction stereotactic radiotherapy as radical treatment. Prior to radiotherapy, all patients underwent insertion of a prostate-rectum biodegradable spacer (PRBS) based on synthetic SHA in the volume of 4–8 mL.

Results. There were no allergic and inflammatory reactions of tissues to the chemical composition of the implanted PRBS. Despite the invasive nature of the procedure, we did not observe any cases of infectious complications.

SНA used in the study demonstrated high levels of hydration (swelling) equal to 24.4 ± 1.5 (20.7–27.3) %, as well as temporal and spatial stability, which determined its optimal characteristics for use as a radiotherapeutic spacer. In all 48 patients, the projected distance (≥1 cm) between the prostate gland and the anterior wall of the rectum was achieved before the start of irradiation. The administration of 4 mL of SНA made it possible to achieve optimal symmetry of the formed space only in one (16.7 %) patient. An increase in the implant volume of the polymer to 6 mL increased the number of such cases to 28.6 %, and after injection of 8 mL it increased to 57 %.

The use of PRBS made it possible to reduce radiation dose to the rectum from 21.5 % (D_0.1cc (dose per 0.1 cm³ of rectum)) (р <0.0001) to 92.8 % (V_{75 %} (volume receiving 75 % or more of the prescribed dose)) (р <0.0001). Dose reduction for one of the most clinically validated parameters – D_2cc (dose to 2 cm³ of rectum)) was 31.5 % (р <0.0001) on average.

Conclusion. Perineal implantation of a non-animal SНA (Russia) as a radiotherapy spacer in patients with prostate cancer demonstrates excellent safety and efficacy profiles.

Background. Prostate cancer is the 2nd most common malignant neoplasms among adult males. Magnetic resonance imaging (MRI) is the method of choice in radiological diagnostics of this disease allowing to noninvasively evaluate the prostate. Currently, the PI-RADS (Prostate Imaging Reporting and Data System) system is widely used. However, its assessment is subjective, or “by eye”, therefore the possibility of enhancing qualitative analysis with quantitative should be considered an excellent prospect.

Aim. To determine correlations between the apparent diffusion coefficient (ADC) and PI-RADS score which will allow to move from subjectivity in evaluation of prostate MRI results and make them independent of radiologists’ experience.

Materials and methods. The pilot retrospective study included MRI data of 28 patients with verified prostate cancer from the period between 2020 and 2022.

Results. Total PI-RADS score showed strong statistically significant negative correlation with mean ADC (r = –0.85; p <0.001) and minimum ADC (r = –0.82; p <0.001). PI-RADS score correlation with prostate-specific antigen level did not show statistical significance (p = 0.162). Total regression was statistically significant (R² = 0.73; F (4.13) = 8.799; p = 0.001). It was found that PI-RADS score depended on mean ADC (p <0.001) and prostate-specific antigen level (p = 0.013). Additionally, linear regression models were developed to predict Gleason score but with the current dataset they did not show statistical significance, possibly due to the small sample size.

Conclusion. The use of quantitative MRI in diagnosis of prostate cancer is a promising method which allows to objectivate PI-RADS score and to decrease the number of unjustified biopsies in the future. The key reason why quantitative MRI cannot be widely implemented is that ADC values are affected by a large number of external parameters, and ADC values can significantly vary in different devices. Therefore, in the future standardization of the prostate scanning protocol with optimal selection of b-value and minimization of factors affecting ADC measurement will allow to achieve more reliable comparative metrics.

Background. Upper tract urothelial carcinoma (UTUC) accounts for only 5–10 % of all urothelial cancer sites. Radical nephroureterectomy is the main treatment method in patients without distant metastases.

Aim. To study survival and assess the impact of preand postoperative clinical and pathomorphological factors on the risk of death in patients with UTUC after surgical treatment.

Materials and methods. The results of surgical treatment of 157 patients with UTUC over a ten-year period were analyzed. Radical nephroureterectomy was performed in 151 (96.1 %) patients. Organ-preserving treatment was used in 6 (5.9 %) cases. Smoking was registered in 64 (40.8 %) patients. Obesity was observed in 40 (36.4 %) of 110 (70.1 %) patients available for analysis. Overall (OS), cancer-specific (CSS), progression-free (PFS), and recurrence-free survival rates were estimated. Univariate and multivariate Cox regression analysis was used to assess the impact of clinical and pathomorphological factors on the risk of patient death.

Results. The 5-year OS, CSS, and PFS were 67.9, 76.5, and 74.2 %, respectively. The 5-year recurrence-free survival was 73.4 %. The 5-year OS in the obese group was 72.7 % versus 56.5 % in the non-obese group (p = 0.042). In obese patients, there was statistically significant predominance of women (p = 0.001), significantly lower proportion of patients with regional lymph node involvement (p = 0.041), and a significantly lower number of smoking patients (p = 0.049). According to multivariate regression analysis, the risk of death was significantly increased in patients with Charlson comorbidity index above 5 (hazard ratio (HR) 2.34; 95 % confidence interval (CI) 1.33–4.11; p <0.001) and regional lymph node involvement (HR 2.78; 95 % CI 1.36–5.70; p <0.001). Multivariate analysis showed that development of non-muscle invasive recurrence in the bladder decreased the risk of death after surgical treatment (HR 0.23; 95 % CI 0.08–0.61; p = 0.003).

Conclusion. Such factors as advancement of the primary tumor and initial somatic status of the patient have negative impact on the risk of patient death after surgical treatment of UTUC. Patients with obesity have better OS, CSS, PFS, are significantly more often female, significantly rarer have regional lymph node involvement and smoke. Development of non-muscle invasive recurrence in the bladder significantly reduces the risk of patient death.

Background. Bladder cancer (С67) remains a serious problem of modern medicine without an established system of active detection. Among male population, bladder cancer is close to such malignant neoplasms as kidney cancer and systemic neoplasms of the lymphatic and hematopoietic tissues, while among female population to oral and brain neoplasms. In terms of 5-year cumulative, observed and relative survival bladder cancer is similar to malignant tumors of the parotid gland (С07) and leukemias (С91–96). Bladder cancer has a higher tendency to recurrence and progression.

Aim. To study for the first time on population level current dynamics of morbidity, mortality, accuracy of registering of patients with bladder cancer in Russia and to evaluate specifics of annual mortality of the patients based on the Population Cancer Registry (PCR) database of the Northwestern Federal District of the Russian Federation (NWFD RF).

Materials and methods. Materials of the International Agency for the Research on Cancer, P.A. Herzen Moscow Oncology Research Institute and N.N. Petrov National Medical Research Center of Oncology reference books were used. Detailed characteristics of the analytical values were established based on the NWFD RF PCR database. For calculation of annual bladder cancer mortality, 27,431 observations were selected from the PCR database.

Results and conclusion. The study allowed to determine the specifics of bladder cancer morbidity in the world, Russia, and NWFD RF, establish age characteristics of the registered bladder cancer cases. Dynamics of bladder cancer morbidity and mortality in Russia and NWFD RF were demonstrated. The negative effect of COVID-19 pandemic was observed. Positive dynamics in mortality and quality of follow-up for patients with bladder cancer were shown. Based in the PCR NWFD RF database, specifics of annual mortality of patients with bladder cancer were determined.

Objectives. To study the efficacy and safety of intravesical gemcitabine (GEM) in comparison to intravesical bacillus Calmette–Guérin (BCG) for patients with high risk non-muscle invasive tumors.

Methods. 100 patients with histologically confirmed non-muscle invasive bladder cancer (carcinoma in situ, Ta, T1), in the high-risk group of urothelial carcinoma, treated in the outpatient clinic of the Urology between 2021 and 2023 who received adjuvant intravesical therapy were simply randomized to group A (BCG group) and group B (GEM group) following single postoperative intravesical instillation of (GEM) chemotherapy after transurethral resection of bladder tumor, each group contained 50 patients were evaluated.

Results. All patients were evaluated for a follow-up of 24 months after treatment. There is no significant statistical difference in clinical and pathological characteristics between the groups. There was no statistically significant difference in the recurrence rate and progression rate of the disease in each group respectively (p = 0.2, 0.06) also overall diseasefree rate (p = 0.128). Regarding safety, free cases of any adverse events were clinically and statistically significant between both groups (p = 0.002). There were statistically significant differences between groups A and B in grade II (hematuria, fever) and grade III (allergy, BCGosis) adverse effects respectively (p = 0.001, 0.003). Although grade I complications were more in the BCG arm, but it was not statistically significant.

Conclusion. The adjuvant intravesical GEM chemotherapy has equal efficacy for BCG immuno-therapy in the treatment of high-risk superficial bladder cancer patients following transurethral resection of bladder tumor. In addition, GEM is associated with reduced local and systemic toxicity compared with BCG.

The article presents a clinical case of treatment of a young man with locally advanced renal cell carcinoma with an inferior vena cava tumor thrombus above the diaphragm. Due to non-standard neoadjuvant approach of using modern tyrosine kinase inhibitors of VEGFR and immunotherapy (VEGFR-TKI/IO) combination pembrolizumab + lenvatinib, thoracotomy was avoided and complete pathological regression of the tumor was achieved. Various studies on neoadjuvant therapy of kidney cancer including in patients with tumor thrombus are discussed, and the prospects for introducing this approach into clinical practice are described.

Malignant tumors affecting perineum skin are rare. The most common neoplasms of this area are squamous cell carcinoma, melanoma, and extramammary Paget’s disease. The most effective treatment for patients with nonmetastatic types of these malignant tumors is surgery. Despite relative technical simplicity of radical resection of the affected skin, the difficulties of defects reconstruction often limits the possibilities of surgical treatment. One of the techniques for replacement of medium-sized and large defects after surgical treatment of anogenital skin tumors is the use of regional fasciocutaneous lotus petal flap. The article presents descriptions of clinical cases of this technique using in 4 patients including 3 women with vulvar cancer and a man with extramammary Paget’s disease.

Autosomal dominant polycystic kidney disease is the most common hereditary kidney disease, but the combination of this pathology with renal cell carcinoma is a rare clinical observation. The main treatment method in this situation is nephrectomy. The article presents a clinical case of a 69-year-old patient diagnosed with left kidney cancer  pT1bN0M0, stage I with autosomal dominant polycystic kidney disease and chronic kidney disease. Due to severe concomitant kidney pathology, the patient underwent organ-preserving surgery in November of 2024 which included resection of the left kidney with fenestration and excision of renal cysts. The early and late postoperative periods were uneventful with preservation of renal function.

Implantation of an artificial urinary sphincter is the most studied and most effective method of surgical treatment of severe stress urinary incontinence in men. If urethral erosion develops at the cuff site, it is only possible to restore the device’s function and regain the previous level of quality of life through a multi-stage procedure.

This paper describes a clinical case of multistage treatment of a patient with urethral erosion at the site of the artificial urinary sphincter cuff and provides a review of the literature.

Recent development of anticancer drug therapy and the improvement of surgical interventions have led to better oncological treatment outcomes for most patients. The introduction of targeted therapy and immuno-oncological agents into clinical practice has allowed previously incurable diseases to be transformed into chronic conditions. While focusing solely on the effectiveness of therapy, many practicing oncologists often pay little attention to another aspect – toxicity. Hypogonadism is a relatively common adverse event (AE) in men undergoing anticancer treatment. The symptoms of this AE (asthenia, erectile dysfunction, mood variability) are often mistaken for complications of drug therapy. Both chemotherapy (CT) and targeted therapy, as well as immunotherapy, can lead to hypogonadism. According to various authors, platinum-based agents can cause the development of hypogonadism in 50 % of cases among young men. Oxaliplatin-containing regimens may result in a decrease in sperm concentration following adjuvant CT for colorectal cancer. Germ cell tumors of the testis, which have high sensitivity to cisplatin-based CT, are among the most treatable malignant neoplasms, even with metastatic processes. The first stage of treatment for germ cell tumors is orchiectomy, which in itself contributes to the development of hypogonadism. Furthermore, when undergoing CT, the risk of this AE increases significantly, up to 50 % in some publications. Considering that this condition affects men of reproductive age with a very high life expectancy, careful monitoring of total testosterone levels is necessary. Uncorrected hypogonadism can lead to various late AEs: obesity, metabolic syndrome, cardiovascular pathology, and osteopenia.

This literature review examines various aspects of hypogonadism in men receiving anticancer treatment and its impact on the development of late complications.