A sample of 63 patients with bladder cancer (BC) was used to estimate the informative value of a noninvasive UroVysion test carried out prior to cystoscopy on urine sediment cells when diagnosing BC recurrences. The latter were detected by either the two techniques (cystoscopy and fluorescence in situ hybridization (FISH) assay) or one of them in 19 patients in different periods after treatment for primary BC (1-36 months). Cystoscopy revealed 13 recurrent BC cases; FISH assay identified 17 cases and in earlier periods. The total sensitivity of the FISH assay was 84.6%. The sample of 20 FISH-positive primary patients showed a direct correlation between BC stage, grade, and the number of abnormal cells (as indicated the UroVysion test) in the urine sediment.

The data of 35 kidney cancer patients with metastases in long bones, who had been operated, were retrospectively analyzed. The role of surgery in patients with long bones metastases of kidney cancer was assessed and application of surgical treatment was ascertained to yield satisfactory results in improving the quality of life and duration of life in patients with solitary bone metastases.

The results of surgical treatment were analyzed in 48 patients with renal cell carcinoma (RCC). Out of them, 31 patients underwent laparoscopic nephrectomy (LNE), 17 had laparoscopic renal resection (LRR). The mean follow-up period was 34.4 months with a standard deviation of ± 17 months).

Our presented series of 17 LRR and 31 LNE cases is comparable with the similar series described in the world literature in terms of surgical parameters, safety, and efficiency. The results of surgical treatment are objectively close to those of virtually complete cure. The wide introduction of organ-sparing surgical procedures is urgent for patients with T1a-bN0M0 RCC.

The paper deals with the specific features of sunitinib tolerance in the treatment of metastatic renal-cell carcinoma. It considers in detail the drug’s side effects that are potential biomarkers of its efficacy.

Over the past quarter-century germ cell tumors are one of the few cancers for which highly effective treatment is found. However there is a lack of awareness of young men and general practitioners about germ cell tumors which is often cause of late medical aid appealability and potential diagnostic errors. Reducing the time between patient's medical aid appealability and final diagnosis may contribute to the diagnostics of germ cell tumors in the early stages, reducing the amount of treatment and improving survival rates.

Oncology statistics shows steady increase of prostate cancer, since early diagnosis and adequate treatment are crucial. Among prostate imaging modalities sonoelastography (SEG) has a special value for identifying suspicious dense foci in prostate, however more studies are still required to establishing accuracy and specificity with different SEG techniques for updating the prostate cancer diagnostics protocol.The aim of study was to evaluate sonoelastography capabilities for ultrasound guided prostate biopsy, comparing with gray scale and Doppler modalities.

512 consecutively selected patients were examined (mean age of 56 years, mean prostate volume was 54 cm3, the average PSA about 14.3 ng/ml). All patients underwent prostate cancer diagnostic algorithm, including direct rectal exam, PSA level, transrectal ultrasound (TRUS) with Doppler and SEG identification of suspicious foci, mostly in peripheral zones, followed by 10-point biopsy guided by ultrasound. According to aim we assigned patients to 4 groups: group 1 (n = 327) underwent gray scale and Doppler US guided prostate biopsy; in patients of group 2 (n = 106) – additionally SEG was applied (3 patients of this group was also performed MRI and MRS of the prostate); in group 3 there were patients with high level of PSA and negative TRUS guided biopsy; group 4 – of 41 patiens with prostatectomy and biochemical recidive of prostate.

Among 430 cases included to this study in 318 patients (74 %) prostate adenocarcinoma was revealed, in 270 (63 %) patients – benign hyperplasia (BH). In group 1 cancer was diagnosed in 236 (72.1 ± 2.4 %) patients, in group 2 – in 84 (79.2 ± 3.8 %). 19 false negative and 6 false positive results were registered in SEG enchanced US guided prostate biopsy. Routine TRUS indicate lesions with mean sizes about 0.8 ± 0,21 sm in compare with 0,5 ± 0,08 sm which were diagnose by SEG. Locuses which were marked as benign byTRUS with SEG hade never conatained neoplastic cells. TRUS guided biopsy in patients of group 3 had estimated prostate cancer in 10 cases (45,5 %) of 22 patients where prostate cancer was assumed after multiparametric MRI. Biopsy confirmed nononcological character of prostate lesions which were marked as benign by MRI. In group 4 all TRUS examinations were unsensitive. – local recurrence was found only in one case in compare with 14 verified cases detected by MRI.

Using ultrasonic guided SEG assisted algorithm is significantly more effective than usial gray scale US for prostate cancer detection. Thus SEG TRUS guided biopsy shown higher cancer detection level over routine gray scale TRUS (p < 0.05): sensitivity was increased from 71 to 77 % (p < 0.05), specificity from 62 to 69 % (p < 0.05). But in complicated cases US diagnostics has to be supplied by multiparametric MRI.

Medications increasing the survival of patients with metastatic castration-refractory prostate cancer (CRPC) are lacking today. In the past 3 years, in the pharmaceutical market there have been a few novel drugs to treat progressive prostate cancer. Abiraterone acetate is an androgen synthesis inhibitor, which is also used to increase the survival of patients with metastatic CRPC that progresses after chemotherapy. The results of treatment for metastatic CRPC depend on a number of factors. Visceral metastases are poor predictors of the course of the disease. The results of abiraterone acetate treatment were analyzed in CRPC patients with visceral metastases.

The results of the maximum of more than 15 years of follow-up of Russia’s first large series of patients after radical retropubic prostatectomy (RPE) were traced. The data of 1367 patients who had undergone RPE at the Clinic of Urology, S.P. Kirov Military Medical Academy, in 1997 to 2003 and at the Clinic of Urology, Russian Medical Academy of Postgraduate Education, in 2001 to 2010 were retrospectively studied. After excluding 626 patients who had an incomplete set of preoperative/postoperative characteristics, a postoperative follow-up of < 6 months, neoadjuvant hormonal or radiation therapy, the trial included 741 patients. Their median age at surgery was 64 years (interquartile range (IQR): 59-68); median prostatespecific antigen (PSA), 8.7 ng/ml (IQR: 6.2-14); median follow-up, 65 months (IQR: 50-87; the maximum follow-up period, 189 months). Out of the 741 patients, 30.2, 28.3, and 41.5% were referred to as D’Amico classification low-, moderate-, and high-risk groups, respectively. Five-, 10-, and 15-year relapse-free survival rates were 80.3, 74.7, and 66.7%; 5-, 10-, and 15-year cancer-specific survival rates were 98.3, 95.9, and 85.7%; and 5-, 10-, and 15-year overall survival rates were 92.5, 81.4, and 64.3%, respectively. The significant predictors of biochemical recurrence were a preoperative PSA level of 10.1–20 ng/ml (p = 0.041), > 20 ng/ml (p = 0.003); pathological stage pT3b–4N0 (p = 0.006) and any stage pT N1 (p = 0.003). Further investigations are needed to identify groups of patients who will have the most benefit from surgery.

The incidence of bilateral testicular cancer is 5% in the total cohort of patients. Synchronous and metachronous testicular cancers are detected in 1-2 and 3% of cases, respectively. The standard treatment for testicular cancer is orchifuniculectomy and that for synchronous or metachronous cancer is organ-saving treatment, testectomy.

The paper describes a clinical case of multiple primary metachronous testicular cancer. A 24-year-old patient underwent surgery (orchifuniculectomy) and received 4 courses of BEP polychemotherapy for embryonal carcinoma of the left testicle at the P.A. Herzen Moscow Oncology Research Institute. After 55 months, a dynamic control examination diagnosed a 9-mm tumor in his single right testis that was thereafter resected. Its histological examination revealed embryonal carcinoma with solitary structures in the immature teratoma. Following 22 months, a control examination showed a recurrence of the disease, for which orchifuniculectomy of the single right testis, followed by hormone replacement therapy, was performed. The follow-up period was 80 months; no recurrence is now observed.

The advent of a variety of new drugs to treat castration-resistant prostate cancer (CRPC), which have demonstrated their efficacy in increasing overall and progression-free survival, has considerably enhanced treatment possibilities in this category of patients. The standard treatment of metastatic CRPC (mCRPC) remains to be first-line chemotherapy with docetaxel 75 mg/m2 in combination with prednisolone 10 mg/day every 3 weeks. The new drugs also available in Russia are cabazitaxel and abiraterone acetate, which are approved for second-line treatment in mCRPC patients treated with docetaxel. The optimum sequence of therapy and the time of its use in view of the heterogeneity of a CRPC patient population remain open.

Отчет о ежегодном конгрессе Европейской ассоциации урологов в Милане (Италия), 15–19 марта 2013 г.

Поздравляем с юбилеем Олега Борисовича ЛОРАНА.

Дмитрию Юрьевичу ПУШКАРЮ – 50 лет.

A detailed anatomical study of the prostate and pelvic organs has been recently relevant. Their anatomical knowledge is directly associated with the improved procedure of nerve-sparing robot-assisted radical prostatectomy, which contributes to the preservation of the anatomical structures responsible for postsurgical erection and urinary continence. The main tasks of radical prostatectomy are effective cancer control, early recovery of urinary continence, and recovery of erectile function.

The literature on the anatomy of the prostate and its adjacent structures is analyzed in the context of nerve-sparing robot-assisted radical prostatectomy.