Objectivе. The purpose of the study – to estimate the prognostic value of preoperative prostate-specific antigen (PSA) doubling time (PSADT) in patients with prostate cancer (PCa) after radical prostatectomy (RP).

Materials and Methods. The preoperative PSADT was determined in 92 patients with PCa who underwent RP in FSBI RRCRST. Incidence of biochemical recurrence and adverse pathologic features after surgery (positive lymph nodes and surgical margins, locally advanced and poorly differentiated tumors) were estimate according to the level of preoperative PSADT.

Results. The correlation between the preoperative PSA kinetics and postoperative pathological findings after radical prostatectomy was shown. Positive lymph nodes (p = 0.04), locally advanced (p = 0.03) and poorly differentiated tumors (p = 0.046) were significantly more frequent in patients with a PSADT ≤ 20,0 months. The role of preoperative PSADT as a predict of relapse-free survival after radical prostatectomy was confirmed. By multivariate analysis preoperative PSADT ≤ 20 months showed a statistically significant increase in the relative risk of biochemical recurrence.

Objective. Our retrospective study is aimed to assess safety, pathological response rate, and long-term oncologic outcomes of radical prostatectomy after neoadjuvant chemotherapy for intermediate- to high-risk PCa.

Materials and methods. Forty-four patients were involved in this study, with a 11.4-year follow-up period, on average. We assessed the RPE results in patients with intermediate and high risk of prostate cancer (PSA>10 ng/ml, Gleason score 7 and more, or clinical stage cT2c and more) after weekly treatment with docetaxel (36 mg/m2 for up to 6 cycles, 21 patients) and compared them with those in the second cohort (23 patients) who met oncologic inclusion criteria but received radical prostatectomy only. The long-term oncologic outcomes in both groups of the patients are reported.

Results. Toxicity has been mostly grade 1-2 in intensity and grade 3 and more complication rate does not exceed 10%. A statistically significant of more than 50% reduction in PSA level (pre- vs. post-chemotherapy) was observed in 52.4% cases. During the 11.4-year follow-up period, improvement in cancer-specific survival (CSS) was noted in 90% of patients from the neoadjuvant chemotherapy group, as compared with 60.9% in radical prostatectomy only group. The biochemical recurrence-free survival (BCR) was 68.5 % and 37.7 %, and the overall survival (OS) was 75.5 % and 54.6 % in the combined treatment group and surgery only group, respectively. However, the differences in BCR and OS were not statistically significant.

Conclusion. The use of neoadjuvant chemotherapy represents a safe and practicable treatment strategy resulting in reduced prostate volume and PSA level. Neoadjuvant docetaxel chemotherapy followed by radical prostatectomy was associated with higher observed BCR and OS, as compared with a surgical treatment only group. A statistically significant improvement of CSS is found in the combined treatment group. Therefore, the benefits of this treatment modality need to be validated for feasible implementation in the modern standard practices of prostate cancer treatment.

Objective. To evaluate the effect of preserving proximal and distal segments of the prostatic urethra on functional and oncological outcomes retropubic prostatectomy.

Patients and methods. 97 men who underwent radical prostatectomy were divided into two groups. The first group (n = 49) included patients with complete retention of the bladder neck and prostatic urethra segments followed urethro- urethral anastomosis. The control group (n = 48) included patients who have not been saved the bladder neck. Continence control produced by the method of monitoring the daily amount of urine in the pad.
Social aspects and quality of life was assessed using conventional questionnaire. Radical surgery was evaluated by «negative surgical margin».

Results. Within 1, 3, 6 and 12 months after surgery the average loss of urine control patients with respect to patients of the study group was 741.3 g vs. 218.3 g, 56.9 g and 16.5 g, 48.7 g, against 8.5 g and 35.6 g from 3.3 g, respectively (for each comparison, p < 0.05). The indicator of the quality of life of the patients of the first group on all end points was significantly higher than those of the second group. There were no significant differences between
the frequency of «positive margins» in patients in the control group and the group with a fully preserved bladder neck (5.8 % vs. 5.4 %, p = 0.65).

Conclusions. Preservation of the bladder neck and proximal and distal segments of the prostatic urethra during radical prostatectomy significantly improved urinary function, and can achieve full satisfaction of quality of life in these patients compared with patients in the control group, subject to the necessary oncologic outcomes.

Prostate cancer (PC) is one of the most burning problems of modern urologic oncology. Hormonal therapy (HT) using medical castration
remains a basic therapy for metastatic PC. HT with a novel class of luteinizing hormone-releasing hormone (LHRH) receptor antagonists is
a promising and effective castration treatment option that has a number of significant advantages over LHRH analogues. The paper reviews the results of trials comparing the efficiency and adverse reactions of HT using LHRH antagonists and analogues and gives those of a Russian multicenter study covering the countrywide experience with degarelix.

Gold treatment standard for penile carcinoma (PC) is amputation. However, removal of the penis gives rise to functional and psychological disorders. In this connection, more and more attention is now given to organ-sparing treatment in patients with PC. The paper describes a clinical case of PC in situ in a 47-year-old patient who has undergone deglavation with plasty.

The main treatment of urothelial carcinoma of the upper urinary tract is organ-sparing surgery. The unavoidability of the latter may be in doubt in unclassified cases (an extensive tumor involvement area of the calycopelvic system in the single functioning kidney and failure to make an adequate optic revision of the zone of interest). Each of these patients requires a special approach at the stage of diagnosis and choice of treatment policy. The paper describes a case of successful organ-sparing treatment for upper urinary tract cancer in the presence of completely doubled right kidney.

The possible way to solve the problems associated with a risk from non-radical tumor removal, inadequate repair and a drastic reduction in renal function after long-term technically challenging in situ parenchymal ischemia resections is a surgical intervention into the kidney removed from the body, which has been preserved by the procedure developed for donor organs, during hypothermia that promotes a severe decrease in the intensity of oxygen-dependent processes in the renal epitheliocytes, followed by autografting of the resected kidney. The main advantages of the extracorporeal technique are the excellent ex corpora visualization of renal structures and the unrestricted time of surgery with good anti-ischemic protection. Resurgery after routine (in situ) resections yields good long-term oncological and functional results in correctly selected patients. Repeated tumor removal after extracorporeal kidney resection is a technically challenging surgical intervention undescribed in the literature.

The paper gives the comparative results of cytological examination of alcohol-induced bladder washouts by liquid-based cytology and conventional cytology in 323 patients, including 150 with suspected bladder cancer (BC) and 173 patients after performed combination or combined treatment for BC. The performed investigation has established that the diagnostic value of liquid-based cytology in diagnosing BC and its local recurrences is 1.3-fold higher than that of conventional cytology.

Objective. Comparison of the immediate results of a radical cystectomy (RC) subsequent orthotopic bladder substitute (OBS) in patients with bladder cancer by a standard technique of Studer and by the modified Hautmann technique with an extraperitoneal arrangement of a neobladder.

Subjects and methods. One hundred and fifty-five patients were undergone RC subsequent OBS in department oncourology of Tyumen Region Oncology Despensery during the period 2001–2014 years. The patients were selected on two groups: one (n = 67) was undergone modified Hautmann»s technique and second (n = 88) was undergone standard technique of Studer. Among patients 1st group of men was 64 (95,5 %), women 3 (4,5 %). Middle age made them 56,4 ± 14,6 years. Among patients 2nd group of men was 78 (88,6 %), women 10 (11,4 %). Middle age made them 56,5±19,5 years. The rate and structure of postoperative complications, repeated operations and a 30‑day mortality was estimated and compared on both groups.

Results. The incidence of complications, repeated surgeries and postoperative mortality outcomes of the patients registered in the 2nd group was 63 (71,6 %), 37 (42,0 %) and 7 (7,9 %) respectively. Incidence in the 1st group was 40 (59,7 %) and 4 (5,9 %) respectively and mortality outcomes weren»t. In structure of complications at patients of both groups prevailed infectious and inflammatory, in 14 cases (35 %) in 1st group and in 19 cases (30,2 %) in the 2nd group. Repeated operations at patients of 1st group were connected with peritonitis in 1 case, urinary fistula in 1 case and bleeding in 2 cases. At patients of 2 groups of a reoperation were carried out for the reason: peritonitis in 8 cases, an eventrate in 13 cases, purulent pyelonephritis – 3 cases, bleeding – 3 cases.

Conclusions. Decrease of rate postoperative complications, repeated surgeries and hospital mortality was detected in 1st group patients. Our modified Hautmann technique with an extraperitoneal arrangement of a neobladder can considered as an alternative to existing methods.

Prostate cancer (PC) is the second most common cancer and the fifth highest malignancy mortality rate in men worldwide. Although PC is detectable in 15-20% of men during life, its death risk is only about 3%. This means that not all PC cases require the same management tactics. The given review analyzes the current investigations searching for molecular biological markers to predict the course of PC and to choose its treatment policy, including that in the development of resistance to androgen-deprivation therapy.

Objective: to evaluate the efficiency of laparoscopic adrenalectomy (LAE) in the surgical treatment of patients with adrenal tumors.

Subjects and methods. In 2011 to 2014, the Clinic of Urology, I.I. Mechnikov North-Western State Medical University, performed LAE in 14 patients (8 men and 6 women). The patients’ mean age was 48.0±4.6 years. Right-, left-sided, and bilateral LAEs were carried out in 7, 5, and 2 cases, respectively. Thus, a total of 16 LAEs were performed in 14 patients. The indications for LAE were mainly primary and metastatic adrenal tumors in our series.

Results. The operations were successfully made in all the 14 patients. There were no conversions. Early postoperative complications, such as bleeding requiring blood transfusion, hypotension, and trocar wound infections, were not observed. The mean volume of intra- and postoperative blood losses was 160 (120-280) ml; the time of surgery was 120 (100-150) min. Postoperative analgesia was conducted within 36 (24-48) hours; intramuscular tramadol 50 mg was used twice daily. The mean time of hospitalization was 4 (3-5) days. Histological examination of the adrenal removed revealed adenocarcinoma in 13 (92.8%) patients and adenoma in 1 (7.2%) case.

Conclusion. LAE is the method of choice in the surgical treatment of patients with adrenal tumors. This operation during a laparoscopic access is as effective as open adrenalectomy and the duration of analgesia, the length of hospital stay and the duration of rehabilitation are comparatively shorter.

Measurement of blood prostate-specific antigen (PSA) levels resulted in an increasing number of performed prostate biopsies and the lower age-adjusted PSA threshold led to a larger number of unnecessary prostate biopsies. Today prostate cancer (PC) is identified in only 35% of the patients with a total PSA level of 4–10 ng/ml and PSA-negative PC occurs in 20–25%. Obviously, PSA as an independent marker has exhausted its diagnostic potentialities. The new PC markers presented in the literature indubitably deserve close attention and further investigation. The most promising markers also include [-2]proPSA and PHI index. According to the latest evidence available in the literature now, [-2]proPSA and PHI index are the best predictors of PC during both primary and secondary prostate biopsy. Some publications show it possible to use the PHI index in planning both primary and secondary prostate biopsies, by constructing risk normograms, in combination with other individual patient examination parameters, including those with the other latest biomarkers of PC. The use of [-2]proPSA and PHI index in everyday practice can assist in increasing the specificity of PC diagnosis and reducing the number of unnecessary prostate biopsies. The apparent importance of the diagnosis of PC at its early stages (including that using the PHI index) made us investigate this topic. Despite a great number of printed papers dealing with this problem, their number continues to increase, but clear guides to make actions in this field are yet to be elaborated and a decision on each specific case is made individually.