DIAGNOSIS AND TREATMENT OF URINARY SYSTEM TUMORS. URINARY BLADDER CANCER
Most cases of new-onset non-muscle-invasive bladder cancer (NMIBC) show a propensity for frequent relapses, commonly progression to invasive cancer, and a significant difference in the long-term results of treatment in patients from one classification subgroup. The role of multiple prognostic clinical, histological, and biological factors is being widely discussed in the literature; however, the results of investigations in this area are contradictory and irreproducible. The problems in the prediction of the course of NMIBC remain to be solved.
DIAGNOSIS AND TREATMENT OF URINARY SYSTEM TUMORS. RENAL CANCER
The main goal in the treatment of kidney tumors is to preserve renal function. Investigations made in the past decades show that chronic kidney diseases (CKD) are much more common than formerly estimated and conventional methods for evaluating renal function frequently reduce the incidence of CKD having more serious consequences than recognized before. CKD leads to renal dysfunction subsequently resulting in renal failure that increases a risk for the development and progression of cardiovascular diseases. Formulas for calculation of glomerular filtration rate on the basis of serum creatinine are presently in common use to evaluate renal function. The MDRD and Cockcroft-Gault formulas are most frequently used. Investigations dealing with the radiological estimation of renal volumes and function are also promising. In patients with renal cell carcinoma (RCC), the differences in cancer-specific and overall survival become significant just 3 years after surgery. Decreased renal function after surgical renal tissue removal in the presence of CKD is one of the significant reasons for no positive changes in the overall survival of patients with RCC. According to the data of different studies, the concurrence of RCC and CKD, which cause diminished renal function, is encountered in a considerable number of patients. Thus, the present-day treatment of patients with RCC should be focused on the optimization of renal function, the prevention of CKD, and the minimization of its degree. Researches to improve renal function in RCC patients who have undergone surgery are regarded as the priorities of urologic oncology.
Data on 19 patients with kidney cancer with metastatic involvement of the vertebral column, who had undergone percutaneous vertebroplasty, were retrospectively analyzed. The role of percutaneous vertebroplasty was assessed in patients with bony metastases from kidney cancer to the vertebral column and this surgical treatment was found to achieve satisfactory results in improving the quality of life in patients.
Targeted therapy is a standard treatment in advanced renal cell carcinoma. Stabilization is an expected response to targeted therapy. The main goal of targeted therapy is to improve progression-free survival. This purpose is served through the sequential use of targeted agents. First-line therapy agents in the good and intermediate MSKCC prognostic groups are antiangiogenic ones such as bevacizumab, sunitinib, sorafenib, pazopanib; in the poor MSKCC prognostic group treatment of choice is an mTOR inhibitor temsirolimus. The antiangiogenic agent axitinib and the mTOR inhibitor everolimus were proved to be effective as second-line therapy. Axitinib administration after anti-VEGF drugs is associated with cumulative toxicity. The efficacy of axitinib in sorafenib-refractory renal cell carcinoma has not been proven. So everolimus remains the agent of choice for second-line targeted therapy. The effect of repeated antiangiogenic therapy may be anticipated after everolimus therapy.
REVIEW
Hormone therapy is a basic treatment for locally advanced and/or metastatic prostate cancer (PC); however, most patients become resistant to first-line therapy in the course of time. Abiraterone is a highly active, selective, irreversible CYP17 inhibitor that prevents the conversion of pregnenolone to dehydroepiandrostenedione and that of progesterone to androstenedione in the testes and adrenals, as well as directly in tumor tissue. This drug is able to considerably improve tumor-specific and overall survival rates in patients with castration-resistant PC (CRPC) and it has been approved by the U.S. Food and Drug Administration to treat this cohort of patients. Despite the efficacy of abiraterone, which has been proven during clinical trials, the disease progresses over time. This literature review deals with the possible mechanisms of resistance to abiraterone. A deep insight into the above mechanisms can open up fresh opportunities for resistance control and improve survival rates in patients with CRPC.
PROSTATE CANCER
In prostatic hyperplasia (PH) and prostate cancer (PC), changes in major cell functions are manifested by impairments in the expression levels of genes and their products, in transmissions, etc. The regulatory components of the renin-angiotensin and kallikrein-kinin systems are known to play a vital role in ensuring the homeostasis of tissue, including that of prostatic tissue. It is promising to elucidate the specific features of these processes in the diagnosis of PC. Polyfocal prostate puncture biopsy specimens were examined in 15 males with PC and 15 with benign PH (BPH). Immunohistochemical reactions were made in an automatic robotic apparatus. B1 expression was ascertained to be fully absent in patients with BPH. Malignant acini and prostatic intraepithelial neoplastic foci showed a specific reaction with anti-B1 antibodies in the glandular epithelium. B2 expression was seen in the stroma in both BPH and PC irrespective of their stage and total Gleason scores. The findings of the pattern of B1 expression suggest that it may be used as a marker for PC.
In the literature devoted to studying of prognostic factors of biochemical recurrence, the important place is taken away to discussion of ultra-sensitive PSA assays. Some researches have shown that the main value of ultrasensitive prostate-specific antigen (USPSA) level can be identification the patients of high risk group for progression and, as consequence, early revealing of disease recurrence. Subject of special studying is presence and definition of a tertiary Gleason grade (TGG) pattern in radical prostatectomy specimens. In the literature appears more and more the data that the TGG is associated with adverse pathology characteristics and a higher risk of biochemical recurrence.
The purpose of the study was to evaluate the efficiency of prostate cancer (PC) treatment using high-intensity focused ultrasound (HIFU) on the basis of morphometric and immunohistochemical (IHC) analyses of postoperative prostate biopsy specimens. The study subjects were 40 patients with localized and locally advanced PC. The postoperative morphological analysis was made on the basis of standard hematoxylineosin staining and morphometric and IHC studies using the following antibodies: PCNA, Bcl-2, AMACR, Е-cadherin, and ANDR (Dako). Pre- and post-HIFU therapy histological examination of the routinely hematoxylin-eosin-stained specimens showed that the therapeutic pathomorphism of the tumor corresponded to grades III and IV. It was established that the IHC study should be used as an additional crite-rion for the efficiency of PC therapy after HIFU ablation. In spite of positive clinical, laboratory, instrumental, and objective changes, the patients with high AMACR and Bcl-2 levels and decreased Е-cadherin expression may be considered as a group at risk for prolonged malignant growth or recurrent PC.
The impact of different prognostics factors on the probability of development local and systemic relups in patient with biochemical recurrence following prostatectomy was studied. By multivariable analysis, predictors of systemic progression were seminal vesicle invasion (pT3b) (p = 0,005), trigger prostate-specific antigen level greater than 2 ng/mL (p = 0,03), prostate-specific antigen doubling time of 6 months or less (p = 0,002) and prostate-specific antigen velocity greater than 0,1 ng/mL per month (p < 0,0001). The rate of systemic progression in patient with not greater than one unfavorable predictor was 6,3 %, with two or greater predictors – 88,9 % (p < 0,001).
CLINICAL CASE
Prostatic stromal tumor (PST) of uncertain malignant potential belongs to a group of rare tumors. The etiology, pathogenesis, and risk factors of this tumor are unknown. Up to now, there have been less than 100 reports of PST in the literature. The major complaints of patients with PST include difficult urination or defecation, blood in urine or semen.
The paper describes a case of Patient I. aged 22 years who underwent PST removal at the Department of Urology, N.N. Blokhin Russian Cancer Research Center, Russian Academy of Medical Sciences, on December 23, 2009. It gives the data of preoperative examination, surgical techniques, and the results of a follow-up within 3 years after surgery.
The clinical case description of an effective surgical treatment of a bleeding renal angiomiolipoma proves the expediency of surgical intervention in treating benign renal tumors.
Phyllodes tumor of the prostate is a rare neoplasm with poorly understood pathogenesis. Histologically, it resembles phyllodes tumor of the breast with hyperplastic epithelium lined cysts and channels embedded in a variably cellular stroma. A variety of terms have been used to describe these lesions, including phyllodes type of atypical hyperplasia, cystosarcoma phyllodes. The malignant potential of this tumor is unclear and has resulted in confusion in terms of prognosis and treatment.
LECTURE
The choice of a technique of treatment of prostate cancer depends on the age of the patient, accompanying diseases and prevalence of tumoral process. The basic methods at an inspection stage at which the cancer stage is defined are: definition of prostate specific membrane antigen, rectal examination, results of the rectal ultrasound guided biopsy, prostate imaging methods and an estimation of a grade of a tumor. Nowadays one of the main directions of determining the treatment for various stages of tumor is the development of prognostic models based on the analysis of predictors for tumor expansion.
ISSN 1996-1812 (Online)