Background. The design and introduction of novel medicaments into clinical practice has confirmed that it is necessary to search for new prognostic factors to re-evaluate the clinical and biological properties of a tumor and to identify a subgroup of patients who will benefit from drug treatment. An individual approach and personalization of performed therapy will be able to substantially enhance its efficiency.

Subjects and methods. Thirty-four oncology and urology research and health care institutions from 8 federal districts of the Russian Federation took part in the investigation. It enrolled 145 metastatic renal-cell cancer patients who had received targeted therapy with a combination of bevacizumab and interferon-α (IFN-α), in whom an objective response (complete or partial regression) or stabilization of tumor foci was recorded during at least 3-month treatment. The main task of the investigation was to estimate the clinical importance of chosen criteria (an interval from the diagnosis to start of treatment; physical activity according to the Karnofsky scale; a history of nephrectomy; the site and number of metastatic foci; the levels of hemoglobin, neutrophils, platelets, calcium, and alkaline phosphatase) as predictors for the efficiency of bevacizumab therapy.

Results. The median follow-up was 9 months (interquartile range (IQR) 6–13 months). The duration of treatment varied between 3 to 22 months; the median was 9 months (IQR 6–13 months). Patients with 3-month progression were excluded from the investigation. A complete and partial responses were recorded in 5 (3.4 %) and 19 (13.1 %) patients, respectively; the tumor process was stabilized in 118 (81.4 %) patients. The median duration of response to therapy with a combination of bevacizumab and IFN-α was 7 months (IQR 5–10 months). The progression-free survival was significantly influenced by prognostic factors, such as hemoglobin and neutrophil levels, age, and time from the diagnosis to starting therapy (p < 0.05). A history of nephrectomy had a significant impact on overall survival (p < 0.05).

Conclusion. Our findings suggest that a history of nephrectomy and elevated neutrophil and alkaline phosphatase levels affect the efficiency of performed treatment in terms of an objective response to therapy. The factors influencing progression-free survival included the levels of hemoglobin and neutrophils, age, and time to diagnosis to start therapy.

Background. The registered AVOREN Phase III trial demonstrated the efficacy of a combination of bevacizumab and interferon-α (IFN-α) as first-line targeted therapy in patients with metastatic renal-cell cancer (mRCC). The median progression-free survival (PFS) was significantly higher in the bevacizumab + IFN-α group, amounting to 10.2 months versus 5.4 months in the IFN-α group (p < 0.0001). The most common grade 3 and 4 side effects in the AVOREN study included the adverse events due to IFN-α use; this initiated a prospective multicenter BEVLiN (Bevacizumab and Low-Dose Interferon) Phase II trial in 2008 to evaluate the efficacy and tolerability of a combination of bevacizumab and low-dose IFN-α in patients with mRCC to diminish the toxicity of treatment.

Subjects and methods. The trial enrolled 146 patients having good and moderate prognosis according to the MSKCC scale. The patients received Avastin 10 mg/kg every 2 weeks and IFN-α 3,000,000 IU thrice weekly. The historical control group was taken from the AVOREN trial as a control group. The main purposes of the trial were to evaluate the tolerability of treatment (the frequency of adverse events due to IFN-α use, grade 3 or more toxicity) and PFS. The additional goals were to estimate overall survival (OS), objective response rates, and the incidence of any adverse events of grade 3–4 toxicity.

Results. The median follow-up was 29.4 months (range 1.5–35.4 months). The rate of objective responses was 28.8 % (95 % confidence interval (CI) 21.4–37.1). The median PFS was 15.3 months (95 % CI 11.7–18.0) and PFS was 58.2 and 28.9 % at 12 and 24 months of treatment, respectively. The median OS was 30.7 months (95 % CI 25.7 was unachieved). In the IFN-α group, all grades of adverse reactions and their grade 3 or more were recorded in 53.4 and 10.3 % of the patients, respectively. The adverse events that were a reason for IFN-α discontinuation were recorded in 24.0 % of the patients.

Conclusion. The BEVLiN trial has shown that IFN-α dose decrease can substantially reduce the frequency of side effects, without worsening PFS and OS rates.

With the clinical introduction of targeted drugs, the results of therapy in patients with metastatic renal-cell carcinoma (mRCC) of all prognostic groups as witnessed by the data of randomized trials. Nevertheless, there is a group of favorable prognosis patients (MSKCC) that may use first-line immunotherapy equally with a targeted approach without apparently affecting overall survival. As a rule, these are the patients who have no symptoms of the disease with the primary tumor being removed and the disease is being minimally disseminated. At the same time, how long very rare (1 %) complete remissions achieved by targeted drugs last, whether they can transformed into complete recovery, and how this may be observed in 3–4 % of cases when immune therapeutic options are used in favorable prognosis patients remain to be investigated. Due to the fact that nonspecific therapy involving cytokines fails to overcome fully the phenomenon of immunological tumor tolerance and has limited antitumor activity, the clinical trials are actively studying the efficiency of more specific immunotherapeutic approaches, such as anti-CTLA-4, anti-PD1 monoclonal antibodies, as well as different vaccination types.

Thus, there is an opportunity to make the immunotherapeutic approach molecular targeted and to integrate it into a drug treatment algorithm for patients with mRCC. Accordingly, the priority for additional clinical trials is to identify predictive markers of response (or resistance) to immunotherapy that can rationalize and individualize this therapeutic approach.

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.

Применение 1-, 3- и 6-месячных лекарственных депо-форм лейпрорелина ацетата в гормональной терапии рака предстательной железы в 9 европейских странах: обзор доказательств и экономическая оценка.

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.

The purpose of the work was to improve the treatment results among patients with clinically local and locally advanced prostate cancer while using neo-and/or adjuvant hormone- and radiotherapy.

Materials and methods. Radical prostatectomy results estimation was conducted among 170 patients. An average survey period continued 35,99 ± 1,88 (1–102) months. An average age was 61,66 ± 0,45 (40–75) years. Moreover, after operation 125 (73,5 %) patients proved to have clinically local forms of prostate cancer (рТ1а,b,c,2aN0М0 – 99, рТ2b,cN0М0 – 26), 25 (14,7 %) patients – locally advanced forms (рТ3a,bN0М0) and 19 (11,2 %) – generalized forms of prostate cancer (рТ4N0М0, рТ2а,bN1М0,). Metastases in pelvic lymph nodes developed among 10 (5,9 %) patients. 43 (25,3 %) patients with ІІ–III stages received neoadjuvant hormone therapy treatment due to maximum androgen blockade scheme. An average neoadjuvant hormone therapy duration: 10,14 ± 1,98 (1–60) months. The typical characteristic of modified radical prostatectomy is accurate ejection of urinary bladder neck and proximal area of prostatic urethra part from prostate gland. Already formed urethra-urethral anastomosis is additionally fixed to lateral part of endopelvic fascia.

Results. An average 3-year survival made up 95,5 ± 3,5 %, 5-year – 84,1 ± 4,7 %, 7-year – 71,7 ± 6,8 % respectively. 3- and 5-year relapse-free survival comprised 87,05 ± 3,20 %, 79.64 ± 3,03 % 67,11 ± 3,93 % respectively. 5-year survival among patients with localized prostate cancer made up 97,18 ± 3,27 %. 48 (28,2 %) patients proved to have biochemical relapse so that they were prescribed adjuvant hormone- and/or radiotherapy treatment. Gleason index ≥ and initial PSA level ≥ 20 ng/ml, and their combination are considered as significant factors that foresee Т > Т2 category and biochemical relapse. For рN+ category initial PSA ≥ 20 ng/ml level is principle. Frequency of disease relapse development was proved after post-operation detection of perineural invasion, tumoral fimbria and lymphatic nodes. Existence of biochemical relapse, surgical fimbria, perineural invasion and metastasis was associated with mortality risk. However, such regularity was not proved for positive lymphatic nodes.

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.

The short-term performance criteria (PSA blood level and prostate volume) were analyzed concerning the complex (hormonal and radiation) treatment of 57 patients with prostate adenocarcinoma, stratified into three disease progression risk groups. Two treatment regimens were differed in the duration of neoadjuvant hormone therapy: 9 or 32 ± 13 months in combination with external beam radiation therapy with a total dose 76–80 Gy. Statistical analysis of the multimodal treatment efficiency criteria of patients with high risk of prostate adenocarcinoma showed the best result (significant decrease of PSA blood level) using a single 9-month course of hormone therapy and subsequent external beam radiation therapy. The prostate volume indicator in the applicable mode of radiation therapy has mixed dynamics, and requires further study as a multimodal treatment effectiveness criterion.

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.

The paper describes a clinical case of treatment and follow-up in a prostate cancer patient with very unfavorable baseline prognosis, bone metastases, and good clinical outcome.

Памяти Алексея Владимировича Люлько.

Памяти Николая Алексеевича Лопаткина.

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.