Vol 9, No 3 (2013)

Prostate biopsy is the principal method of diagnois of prostate cancer, allowing to start the adequate treatment. The tactics of the patients, which have negative initial biopsy, is a subject of discussion. Saturation biopsy is a “gold standard„ of diagnostics of PCA with repeat biopsy. Saturation biopsy of the prostate is not a primary procedure, usually apply in patients with negative biopsies in anamnesis, patients with multifocal PIN and ASAP. Saturation biopsy allows to more precisely predict the volume and degree of malignancy of PCA, that can be used for planning tactics of active surveillance and focal therapy.

Objective: to evaluate the impact of dissection of the dorsal venous complex without pre-ligation, suturing, or coagulation during radical prostatectomy (RPE) in patients with localized prostate cancer (PC) on the quality of surgery and the function of urinary retention.

Subjects and methods. The data of 42 patients who had undergone posterior and anterior anatomical repair and vesicourethral anastomosis using a V-lock suture after prostatectomy were analyzed. All the patients were divided into 2 groups. Group 1 consisted of 22 patients in whom the dorsal venous complex was closed using a 3-0 vicryl suture before urethral dissection. Group 2 included 20 patients in whom the urethra was dissected without suturing the venous complex.

Results. In group 1, complete urinary retention after catheter removal was noted in 9 (40.9 %) and 15 (68 %) patients within 24 hours and after 3 months, respectively. Following 12 months, two (9 %) patients were observed to have partial mild urinary incontinence (as many as 2 pads per day). Group 2 patients showed complete urinary retention in 17 (85 %) cases on the first day after catheter removal; all the patients retained urine 3 months later.

Conclusion. In patients with localized PC, dissection of the dorsal venous complex without presuturing during laparoscopic RPE exerts a considerable impact on the preservation of urinary retention, namely 45% more of the patients reported complete urinary retention in early periods and 10 % more did this in later periods. At the same time, there was no statistically significant increase in intraoperative blood loss (p > 0.05), the number of positive edges, or biochemical recurrences.

No consensus on how to select patients is one of the factors restricting the wide acceptance of active surveillance (AS). The frequency of unfavorable histological findings and long-term overall and relapse-free survival rates were studied in 152 patients who met the ERSPC [European Randomized Study of Screening for Prostate Cancer] (PRIAS) criteria for AS and had undergone retropubic prostatectomy (RPE) in the period 1997 to 2010. Negative histological characteristics were found in more than 10 % of the patients, with the median postoperative followup of 67 months biochemical recurrence developed in 3 (2 %) patients. Five- and ten-year relapse-free survival rates were 97 and 88.2 %, respectively. Histological and long-term oncological results after RPE are suboptimal in the patients meeting the PRIAS criteria. There is a need for additional studies of the safety and efficiency of AS under conditions of Russian public health.

Purpose. To evaluate influence of clinical, biochemical and histological factors to biochemical relapse free survival (BRFS) following salvage radiotherapy (RT) in men with biochemical recurrence after radical prostatectomy.

Material and methods. 77 patients with newly diagnosed biochemical recurrence (BR) after RPE were included into retrospective study. All of them underwent local salvage RT. Сlinical variables (age, serum prostate-specific antigen [PSA] level and PSA kinetics, time RPE-BR, Gleason grade, stage after RPE and clinical findings) were evaluated using Cox proportional hazards regression analysis.

Results. The median, 1- and 3-year BRFS were 19,9 months, 63,8 ± 6,5 % and 24,7 ± 8,5 % respectively. Significant variables in the multivariable model were age, PSA level before RT, prostatectomy T3b stage, PSA doubling time and positive digital rectal examination findings (p < 0,05). Several clinical parameters help predict the outcomes of men with PSA elevation after radical prostatectomy. These data may be useful in counseling men regarding the timing of administration of adjuvant therapies.

We report a case of a 45-year-old man with testicular cancer. The patient received radical orchiectomy. After the diagnosis of nonseminomatous testicular cancer (embryonic carcinoma), he was treated successfully with 4 cycles of systemic chemotherapy. After 3 months admitted with respiratory distress and found to have mass in right ventriсle of the heart. This is a rare case that presented with metastatic testicular cancer involving heart and causing symptomatic obstruction of blood flow tract.

Памяти Алексея Владимировича Люлько.

Defect of the embryogenesis of the three paired cardinal veins and their anastomoses leads to the formation of the inferior vena cava abnormalities. Congenital anomalies of the inferior vena cava (IVC) and its tributaries are usually asymptomatic. The computed tomographic (CT) imaging with intravenously administered contrast material is used for identification of the vascular structures and abnormalities. Knowledge of the anomalies of the vessels help the surgeons to avoid the development of complications by the para-aortic lymph node dissection in patients with neoplasm’s of the testis, kidney, and female genital tract. This article reviews the classification, embryogenesis, anatomy, CT imaging and clinical significance in para-aortic lymphadenectomy of the variants of the IVC and its tributaries.