To reveal possible associations of the polymorphic variants of the cytochrome P450 and enzymes glutathione-S-transferase genes with the risk for bladder cancer (BC), the authors analyzed the frequency of genotypes and alleles at the polymorphic loci of the CYP1A1 (A2454G), GSTM1 (del), and GSTP1 (A313G) genes in 208 patients diagnosed as having BC (104 patients with invasive BC and 104 with superficial BC) and in 367 patients without identified oncopathology. The *1A*2C (OR = 3.42) and *2C*2С (OR = 6.98) genotypes, *2C (OR = 3.73) allele of the CYP1A1 gene and the GG (OR = 2.53) genotype of the GSTP1 gene were ascertained to be genetic markers for a risk for BC. The presence of the *2C (OR = 1.69) allele of the CYP1A1 gene, the G (OR = 2.40) allele and the AG genotype (OR = 2.40) of the GSTP1 gene was associated with the invasive forms of BC. There were no substantial differences in the distribution of the frequency of genotypes of the GSTM1 gene between the samples of patients and healthy individuals.

Whether cross-polarization (CP) optical coherence tomography (OCT) could be used to detect early bladder cancer was ascertained; it was compared with traditional OCT within the framework of blind (closed) clinical statistical studies. One hundred and sixteen patients with local nonexophytic (flat) pathological processes of the bladder were examined; 360 CP OCT images were obtained and analyzed. The study used an OCT 1300-U CP optical coherence tomographer. CP OCT showed a high (94%) sensitivity and a high (84%) specificity in the identification of suspected nonexophytic areas in the urinary bladder.

Objective: to evaluate the efficiency of beam radiotherapy (BRT) in patients with non-muscle-invasive bladder cancer (NMIBC).

Subjects and methods. The data on 40 patients diagnosed as having stage T1 NMIBC, who had been treated at the Medical Radiology Center in 1990 to 2009, were studied. Of them, 75% were aged < 70 years. They all had verified transitional cell carcinoma: G1 in 11 (27.5%) patients; G2 in 12 (30%), and G3 in 17 (42.5%). Multifocal tumor growth (T1m) was found in 22 (55%); the largest tumor exceeded 3 cm in 31 (77.5%). More than half (60%) of the patients had clinically significant concomitant diseases. Three (7.5%) had a history of treated malignancy. The mean follow-up of the patients was 58.6 months.

Results. Survival at 60 months follow-up was 67.9 ± 8.0%. Three (7.5 %) patients died at 21–42 months follow-up. Five-year relapse-free survival was 50.0 ± 8.5%. Seven (17.5 %) patients were withdrawn at 5 to 99 months follow-up (mean 34.7 months). Four (10 %) patients died from disease progression at 21 to 143 months follow-up. After radiotherapy to the bladder area, 17 (42.5 %) patients were diagnosed as having more than 50 % tumor regression, which permitted transurethral resection of a residual tumor. The frequency and degree of radiation reactions were estimated. Acute radiation cystitis was diagnosed in 11 (27.5 %) patients and rectitis was found in 6 (15.0 %). Radiation reactions were not a reason for forced treatment discontinuation. Grade I-II late radiation cystitis (RTOG/EORTC) was diagnosed in 9 (22.5 %) patients.

Conclusion. The efficiency of BRT in patients with NMIBC who had refused surgical treatment or had contraindications to it was confirmed during the study. BRT could preserve the functioning bladder in 97.5 % of cases and remove the residual tumor in 42.5 %. Radiation reactions were not a reason for forced treatment interruption.

The only factor that demonstrates its independent influence on overall survival in our series of observations is surgical radicality (p < 0.0001). This conclusion underlines the importance of the quality of surgical treatment for the prognosis of the disease. Surgical access and scope should be individually determined by the site, sizes, and hypothetical pathomorphological characteristics of a tumor. Correct choice of surgical tactics serves as a pledge to completely remove all afflicted tissues. The efficiency of neoadjuvant and adjuvant chemotherapy for pelvic and ureteral tumors has not been proven. The additional treatment has failed to affect survival in this study.

Comparison of the results of preoperative spiral computed tomography (SCT) in 107 patients with renal tumors and postoperative biopsy data revealed differences in the sensitivity and specificity of SCT phases in the diagnosis of cancer and other space-occupying lesions of the kidney. Based on the results of the study, the authors propose an optimal SCT diagnostic protocol, by using certain SCT phases and their combination in patients with renal space-occupying lesions in relation to the objective of a forthcoming study. SCT protocol optimization is an important moment that allows reductions in a radiation burden on the patient on the one hand, and in the cost of the urological use of this high-tech
radiodiagnostic technique on the other.

Prostate cryoablation is an effective mini-invasive treatment for prostate cancer (PC), which may be used in case of both primary and postradiotherapy recurrent tumor. Due to continuous improvements of cryoablation equipment, the number of treatment-induced complications is small. The studies of
long-term cryotherapy outcomes, such as cancer-specific, metastasis-free, and other survival rates, are presently under way. Focal cryoablation of the prostate remains an experimental therapy option.

Background. Prostate-specific antigen is the most commonly used serum marker for the early detection of prostate cancer (PC). However, the specificity of the test is low and accounts for about 20%. The study of the regulatory functions of proteinases and their inhibitors in carcinogenesis is promising in terms of developing methods for the early cancer diagnosis.

Objective: to analyze impaired proteolytic processes in the secretion of the prostate in its benign hyperplasia (BPH) and PC, by determining the key indicators of the kallikrein-kinin and renin-angiotensin systems and the activity of leukocyte elastase in the prostatic secretion.

Subjects and methods. Group 1 included 20 patients with PC (mean age 62.7±2.3 years). Group 2 comprised 20 men with BPH (mean age 62.2±1.4 years). A control group consisted of 20 healthy men (mean age 35.6±4.5 years). The prostatic secretions from the patients of all the groups were used to estimate the indicators of proteolytic systems: kallikrein activity, prekallikrein levels, the inhibitory activity of α1-proteinase inhibitor (α1-PI), and α2-macroglobulin (α2-MG), and the activity of angiotensin-converting enzyme (ACE) and elastase and elastase-like activity.

Results. Comparative analysis of the specific features of impaired proteolytic processes during benign and malignant prostate processes indicated that in PC the prostatic secretion showed a 39.2% increase in the activity of kallikrein (p < 0.001) and a 41.3% reduction in that of ACE (p < 0.001) as compared to those in BPH, which seems to reflect a decrease in prostatic secretion angiotensin II levels. PC is characterized by a drastic rise in the inhibitory potential of prostatic secretion; for the prostatic secretion activities of α1-PI and α2-MG are 56.9 (p < 0.001) and 96.8% (p < 0.001) respectively, higher than those in BPH. There are 2 statistically significant criteria for PC diagnosis: the activity of kallikrein and ACE with 75.0% specificity and 66.7% sensitivity.

Conclusion. An imbalance between proteinases and their inhibitors has been found in the prostatic secretion in PC and BPH, which is the basis for biochemical individuality of cancer transformation processes in the prostate and may be used in future as a marker for the diagnosis of PC.

Objective: to assess a correlation between the preoperative prognostic characteristics and the pathologic stage and to determine whether a positive surgical margin is present after radical prostatectomy (RPE).

Materials and methods. The materials of 224 patients with prostate cancer (PC) who had undergone RPE at the Clinic of Urology and Surgical Andrology, Russian Medical Academy of Postgraduate Education, were analyzed.

Results. The patients’ median age was 62 (43–78) years. Sixty-seven (29.9 %), 46 (20.5%), and 111 (49.6 %) patients were referred to as low-, moderate-, and high-risk groups, respectively. A positive surgical margin was observed in 11.9, 28.3, and 38.7 % of the patients in the low-, moderate-, and high-risk groups, respectively (р = 0.0003). The predictors of a positive surgical margin were the percent of involved biopsy specimens (R = 0.34) and Gleason score (R = 0.31) and perineural invasion. According to multivariate analysis, neither the preoperative level of prostate-specific antigen, nor the clinical stage showed any correlation with the positive surgical margin and the pathologic stage after RPE.

The article analyses the first experience of male urinary incontinence surgical treatment using transobturator sling system “UroSling male”. This new device is specially designed for transobturator placement with atraumatic fixation onto the inferior rami of pubic bones. The results of the study showed that synthetic sling implantation is an effective and safety option (overall effectiveness of operation 79,5 %).

The authors describe their experience in treating patients with prostate cancer (PC). The data of 68 patients undergoing beam therapy in combination with long-term hormonal therapy are restrospectively analyzed. The patients mainly present with locally advanced tumors. Radiotherapy was performed with a cumulative focal dose of as high as 70 Gy; hormonal therapy involved orchiectomy or long-term adjuvant therapy with luteinizing hormone releasing-hormone analogues for 36 months. Five-year outcomes were estimated; relapse-free and biochemical progression-free survival rates were 88.9 ± 4.9 and 89.4 ± 5.3%, respectively. Early and late radiation damages were also evaluated: the rate of grades 2 and 3 acute radiation-induced urinary tract lesions was 64.3 and 3.6%, respectively; that of grades 1 and 2 gastrointestinal lesions was 26.8 and 7.1%; and that of grade 2 late lesions was not greater than 1.5%.

Background and objective. The division of patients with disseminated prostate cancer (PC) into prognostic groups may be potentially used for a differential approach to choosing the hormonal therapy (HT) option and regimen. This study was conducted to identify factors influencing survival, as well as prognostic groups in this category of patients.

Subjects. The study enrolled 113 patients with verified cT2b–4N0–1M0–1 stage PC. Their median age was 70.0 ± 7.3 years. The median pretreatment prostate-specific antigen (PSA) concentration was 309.8 ng/ml. The stage cT2 was diagnosed in 12 (10.6 %) patients; cT3 was in 85 (75.2 %); cT4 in 16 (14.2 %); cN+ in 32 (28.3 %); М+ in 74 (65.5 %). The median baseline Gleason score was 3.0± 0.8 ± 4.0± 0.9 =7.0± 1.6. All the patients received emergency HT: castration was carried out in 2 (1.8 %) patients; maximum androgenic block and antiandrogen monotherapy were performed in 96 (85.0 %) and 15 (13.3 %), patients, respectively. The median follow-up was 31.9± 17.7 months.

Results. Five-year progression-free, hormone-refractory prostate cancer-free, specific, and overall survivals (OS) were 29.7, 31.8, 39.3, and 26.0 %, respectively. Multivariate analysis has shown that OS is negatively influenced by the following factors: bone pain, stages cT4, М+, a nadir of PSA of  4 ng/ml (p < 0.05) and its baseline level of  100 ng/ml (р = 0.057). Good (no bone pain, a PSA level of < 100 ng/ml, сТ < T4, and М0) and poor (bone pain and/or a PSA level of  100 ng/ml, and/or stages cT4 and/or М+) prognostic groups were identified. The median OS in the groups was 39.8± 3.9 and 29.8± 4.2 months, respectively (р = 0.048).

Conclusion. In disseminated PC, bone pain, a PSA level of 100 ng/ml, cT4 and M+, and a PSA nadir of  4 ng/ml are poor predictors of OS. The patients without these indicators belong to a good prognostic group; those have one sign or more do to a poor prognostic one.

Prostate cancer (PC) is one of the most pressing problems of urologic cancer due to higher morbidity from this pathology worldwide. Treatment policy in PC patients is determined by the extent of a cancer process. Radical therapy for metastatic PC is impossible, hence this patient group is considered eligible for palliative hormonal or chemotherapy. To choose the optimal treatment for patients with hormone-refractory PS (HRPS) is an intricate problem regarding particularly patients with asymptomatic HRPS and those with progressive cancer after chemotherapy with docetaxel. In this instance, the treatment policy is a matter of discussion and is not well defined. The paper considers the use of somatostatin analogues as an alternative to drug therapy for patients with HRPS. Octreotide is one of the most popular drugs of this group. The agent may be used to treat patients with HRPS both before and after systemic cytotoxic therapy. Octreotide therapy is effective and safe; its side effects are minimal and it is well tolerated in patients.

Background. Polypoid cystitis may simulate urothelial neoplasias cystoscopically and histologically. The frequency of polypoid cystitis is 0.38%; that among patients undergoing bladder catheterization is 6 %.

Subjects and methods. The authors estimated the frequency of polypoid cystitis among chronic cystitis patients admitted to City Clinical Hospital Fifty, a base of the Clinic of Urology, Moscow State University of Medicine and Dentistry, in the period from February 2008 to February 2010. Out of 819 patients followed up, 3 who had diagnosed as having polypoid cystitis complained of pollakiuria, imperative micturate urges, and macrohematuria. They underwent ultrasonography, computed tomography, and cystoscopy; bladder masses measured 1.0, 7.0, and 11.5 cm, respectively; extensive growth was verified in 2 cases. Endoscopic studies identified procumbent rough-villous masses without well-defined outlines with the signs of bullous edema, decay, hemorrhages, and urinary salt encrustations. By taking into account the clinical picture and laboratory and instrumental findings, the authors suspected stage T3bNхMх bladder tumor in 2 patients and T1NхMх stage in 1. According to the European Association of Urology guidelines for management of bladder cancer, the patients underwent transurethral bladder resection. The patients were diagnosed as having polypoid cystitis on the basis of postmortem evidence.

Results. In this study the frequency of polypoid cystitis was 37 %. Polypoid cystitis, a benign mass without a risk for malignancy, had signs of invasive transitional cell carcinoma.

Conclusion. Such cases that rarely occur in practice are of clinical value and interest to urologists, pathologists, and oncologists.

Neuroendocrine carcinoma of the prostate belongs to the so-called small-cell neuroendocrine carcinomas and amounts to 1–2 % of all prostate malignancies. With allowance made for the low incidence of this pathology, the paper describes a case of high-grade neuroendocrine (small-cell) prostate cancer with an aggressive course.

The review of current insights into the role of the previous inflammation in the prostate gland and the development of prostate cancer are presented. The consecutive changes of cellular structures are characterized by proliferative inflammatory atrophy and prostatic intraepithelial neoplasia.