The investigation examined the feasibility of cross-polarization optical cohe-rence tomography (CP OCT) to detect early urinary bladder cancer (UBC). Studies were performed in 376 patients; 5290 images were obtained using an OCT 133-U optical coherence tomograph. To acquire and compare intrared-light scattering images in baseline and orthogonal polarizations is the basis of CP OCT; their analysis makes it possible to judge from the state of the epithelium/connective tissue system and to obtain information on changes in tissue depolarizing components, collagen in particular. The authors elaborated criteria as determinants of the nature of CP OCT changes in direct and orthogonal polarizations in health, inflammatory changes, and UBC at its early stage - urothelial dysplasia and carcinoma in situ in flat suspected areas.

The study revealed a reduction in the chemotrypsin-like activity of the total pool of proteasomes and their 26S and 20S pools in the tissue of clear-cell carcinoma of the kidney versus intact tissue. Renal cancer tissue was found to contain the higher levels of the proteasome subunits α1α2α3α5α6α7 than did intact tissues, which was accompanied by the lower content of the subunits LMP2 and PA28β. A urinary bladder tumor showed the enhanced activity of the 26S proteasomes and the lower expression of α1α2α3α5α6α7 and the elevated level of the LMP2 subunit as part of proteasomes. Intact renal tissue 26S proteasome activity was found to be related to late tumor spread. Urinary bladder cancer tissue showed a correlation between the expression of the proteasome subunits α1α2α3α5α6α7 and the size of a tumor and that between 26 proteasome activity and the degree of histological tumor differentiation.

Synchronous renal cell and urothelial carcinomas are rare in the same patient. The paper describes the epidemiology, diagnosis, and treatment of the given type of pathology and presents the data of the authors observations and the specific features of each specific case.

Target drugs acting via the HIF/VEGF pathway show a steady-state clinical effect in treating patients with metastatic renal cell carcinoma (RCC). However, to continue therapy in patients with developing resistance in the prolonged use of tyrosine kinase inhibitors remained unsolved, which brought about a search for alternative pathogenetic pathways and new effective appropriate medicines. One of its solutions was the mTOR pathway and everolimus acting via it. Motzer et al. conducted the RECORD-1 phase III international multicenter randomized double-blind placebo-controlled study of the efficiency of everolimus. The study enrolled 410 patients with metastatic RCC that progressed during target therapy with sunitinib and/or sorafenib. The study was interrupted before the appointed time, as recommended by the Independent Data Monitoring Committee since the established effectiveness threshold values and conformity criteria for a positive study result were achieved. According to an independent centralized assessment, everolimus reduced the risk for disease progression by 70% (p < 0.0001). The median progression-free survival was longer in the everolimus group than that in the placebo group, which was 4.9 and 1.9 months, respectively (p < 0.0001). Final double-blind analysis showed a partial response in 5 (2%) patients and disease stabilization in 185 (67%) patients in the everolimus group; there were no patients by the former indicator and 45 (32%) patients by the latter in the placebo group. The final findings showed no statistically significant difference in overall survival rates between the groups: the median overall survival was 14.78 and 14.39 months in the everolimus and placebo groups, respectively (p = 0.177). This might be due to a cross impact because 79 (81%) of the 98 patients from the placebo group were switched over to open-labeled everolimus taking after disease progression. Everolimus demonstrated a good tolerability and safety. Grade III-IV toxicity was recorded in 5% of patients. In the everolimus-taking patients, the most common adverse reactions of all severity degrees were stomatitis (36%), eruption (28%), fatigue (23%), asthenia (22%), and diarrhea (21%). The hematological reactions included anemia (25%), hypercholesterolemia (18%), and hyperglycemia (8%). Everolimus is now the first and only registered drug to treat metastatic RCC if therapy with tyrosine kinase inhibitors is ineffective.

Failures of BCG therapy for muscle noninvasive carcinoma of the urinary bladder are classified as BCG refractoriness, BCG resistance, postBCG-therapy recurrences. Some patients are observed to be BCG intolerant, which makes the therapy discontinued. Detectable BCG refractoriness and early recurrences are associated with a high risk of progression and high tumor-specific mortality and are indications for emergency cystectomy. Preference should be given to early cystectomy if high risk group patients have additional poor prognostic factors for disease progression. In patients with BCG therapy failures, medical treatment should be performed only within research programs.

The paper reviews the literature on the treatment of renal cancer, mainly on postoperative immunotherapy. It outlines a role of cytokines in tumor-immune system interaction, the prognostic value of the level of expression of each cytokine for both survival rates and the efficiency of immunotherapy, as well as the use of this information to develop new therapeutic approaches.

Objective: to study the feasibility of the image fusion technology to choose a target portion for needle biopsy in prostate cancer (PC). Subjects and methods. Ultrasound (US)-magnetic resonance imaging (MRI)-guided needle biopsies were made in 12 patients. All the patients underwent intravenous bolus-enhanced MRI, then MRI and US images were fused during transrectal ultrasound studies (TRUS) and targets were determined to make a needle biopsy. Results. The image fusion technology allows one to concurrently assess MRI and US images in the primary diagnosis of prostate cancer and after radical prostatectomy (RPE). The MRI and transrectal images are compared with a high degree of accuracy, providing the clear positioning of the portions substantially accumulating the MRI contrast agent during real-time TRUS. Conclusion. The MRI-US image fusion procedure enables the choice of the targets to be biopsied both in the primary diagnosis of PC and in its suspected recurrence in patients after RPE. The increased accumulation of a MRI contrast agent is a major criterion for choosing a target portion.

Background. As a common disease, prostate cancer (PC) has taken now first place among all malignancies in many countries of the world.The authors have analyzed the results of their series of robot-assisted radical laparoscopic prostatectomy (RALP) in patients with PC. They also present a number of surgical techniques that may be useful for novice surgeons. Materials and methods. In November 2008 to November 2009, the Department of Urology, Moscow State University of Medicine and Dentistry, performed 80 RALPs using the da Vinci S surgical robotic system. The patients’ mean age was 63.7 (49–71) years; the mean blood level of total prostate-specific antigen was 6.1 (2.1–20.84) ng/ml; the mean prostate volume was 44 (18–94) cm3, as evidenced by transrectal ultrasound study. The authors analyzed the following indicators: operating time, degree of blood loss, conversion of surgical intervention,degrees of intra- and postoperative complications, and oncological and functional results. Results. In our series, RALP was performed without preserving neurovascular bundles or by using a nerve-sparing procedure in 66 (82.5%) and 14 (17.5%), respectively; 22 (27.5%) patients underwent lymphadenectomy. The average length of hospital stay was 7 (4–21) days; the mean time of urethral catheter removal was 10 (6–21) days postoperatively. The mean time of surgical intervention was 174 (121–276) min. Mean blood loss was 248 (35–1950) ml. Postmortem study revealed a positive surgical margin in 19 (24%) cases and tumor invasion into the seminal vesicles in 5 (6%) patients. Stages pT2 and pT3 were found in 56 (70%) and 24 (30%), respectively; total Gleason scores were 6 (3+3), 7 (3+4), 7 (4+3), 8 (4+4) in 38 (47.5%), 35 (43.75%), 5 (6.25%), and 2 (2.5%) patients, respectively. Among 34 patients examined 3 months after RALP, 28 (82.4%) patients completely retained urine; 5 (14.7%) applied not more than a pad a day. In patients with preserved erectile function, the latter cannot be presently evaluated because the follow-up was short and operations performed by a nervesparing procedure were few. Conclusion. The results of analyzing our series of RALP, by using the da Vinci S surgical robotic system, are similar to those of analyzing the first experience with such interventions performed by foreign colleges. By taking into account a small number of our cases analyzed, it is difficult to speak reliably about complications caused by RALP. Studies involving a large number of cases are needed to reliably estimate these findings and to analyze a postoperative period and functional results.

The found changes in the blood coagulation system, serum and prostate tissue spectral analysis, and immunological changes show the development of occult disseminated intravascular coagulation and systemic inflammatory responses caused by endothelial damage, microcirculatory disorders, lipid peroxidation, and release of inflammatory factors. The findings will allow one to elaborate a tactic for medical prevention of complications.

The study of postbrachytherapy complications identified a number of factors that significantly influenced the development of lower urinary tract (LUT) complications. These factors may include prostate volume and preoperative degree of LUT symptoms. The combined effect of these factors increases a risk for the complications.

Overall survival is about 100% in patients with stage I germinogenic testicular tumors after orchifuniculectomy, which is achieved, by applying alternative adjuvant approaches. The use of approaches, such as a follow-up, chemo- and radiotherapy, may be recommended in seminoma. The paper shows the advantages and disadvantages of these methods.