Objective: to assess the role of palliative nephrectomy in disseminated kidney cancer patients planned to undergo targeted antiangiogenic treatment.

Subjects and methods. The investigation included data on 83 patients with T1-4N0 / +M1 disseminated renal cell carcinoma (RCC) who had received at least 2 targeted therapy cycles in 2009 to 2011. In 48 (57.8 %) patients, the treatment was preceded by palliative nephrectomy that was not carried out in 35 (42.2 %). Before starting targeted therapy, all the cases were confirmed to be diagnosed with clear cell RCC, with a sarcomatoid component being in 7 (8.4 %) patients. The median follow-up of all the patients was 21 (12–36) months.

Results. The unremoved affected kidney in disseminated kidney cancer patients receiving targeted antiangiogenic therapy is an independent factor for the poor prognosis of progression-free (odds ratio (OR), 2.4; 95 % confidence interval (CI), 1.2–4.7) and overall (OR, 2.8; 95 % CI, 1.3–6.3) survival. Palliative nephrectomy does not improve the prognosis in patients with a low somatic status, the N+ category, and metastases into the bones and nonregional lymph nodes.

Conclusion. Palliative nephrectomy in the selected patients with disseminated kidney cancer on targeted antiangiogenic therapy increases progression-free and overall survival.

The paper gives the results of studying the urinary levels of markers of acute kidney injury (AKI) in 46 patients with renal cancer during separate ureteral catheterization before the surgery and 24 hours after laparoscopic partial nephrectomy performed due to elective indications under warm ischemia. The levels of cystatin C, neutrophil gelatinase-associated lipocalin (NGAL), liver-type fatty acid-binding protein (L-FABP), and interleukin-18 were examined by enzyme immunoassay. It has been established that the risk of early postoperative AKI may be predicted from the baseline urinary levels of cystatin C and LFABP in patients with renal cancer resulting from 15-20-min warm ischemia time during the partial nephrectomy. An approach based on estimation of the baseline urinary levels of cystatin C and L-FABP to be incorporated into a preoperative examination scheme is proposed for surgical treatment policy choosing in patients with renal cancer. A scheme for examining patients with renal cancer is also suggested for the risk of complications and the degree of AKI assessing in the early post-operative period.

Renal cell carcinoma (RCC) is the most common primary tumor of the renal parenchyma. Venous involvement is one of the most important anatomic characteristics of tumor. It is known that venous spread influences the survival of patients with RCC. Tumor thrombosis of IVC in patients with renal cell carcinoma has been reported in 4–10 %. The reference standard for RCC with tumor thrombus remains surgical resection. The structure of thrombus determines some technical difficulties in the management of tumor. Spongeous thrombus correlate with higher risk of thrombus detachment during surgery resulting in PE. Therefore determination of IVC thrombus consistency is very important part of preoperative radiologic assessment of tumor in patients with RCC.

Paraneoplastic syndrome is not a common concomitance of urothelial tumors. The literature describes a few tens of clinical cases in which urothelial cancer has become a cause of marked nonspecific tumor-associated reactions, associated with the presence of the tumor. Bladder tumors are at stake in all cases. The given clinical observation describes paraneoplastic manifestations in high-grade urothelial carcinoma of the kidney. It demonstrates difficulties in differential diagnosis and gives a retrospective estimate of diagnostic and therapeutic tactics.

Vascular repairs in oncology practice improve quality of life and survival in patients. There is tumor involvement of the inferior vena cava (IVC) and complete removal of its segment followed by repair and the removed IVC portion may be replaced with auto-, allogeneic, and xenogeneic grafts. The purpose of the replacement is to recover adequate venous drainage if acute IVC occlusion develops intraoperatively. The paper describes a case of successful treatment in a 61-year-old female patient with an occasionally detected large right kidney tumor and intraoperative signs of IVC invasion. Radical surgery was performed resecting an IVC fragment and replacing it with a tubularized xenopericardial graft without repairing the ostium of the left renal vein. The postoperative period was uncomplicated. The patient was discharged in satisfactory condition; targeted therapy was recommended. At 6-month follow-up, there were neither signs of tumor progression nor IVC occlusion.

Background. Experience with combination treatment, i.e. systemic therapy in combination with palliative surgery, in the treatment of metastatic kidney cancer is very rarely described in world literature.
Objective: to evaluate the efficiency of combination treatment in combination with palliative cytoreductive surgery and targeted therapy and to define optimal indications for combination treatment.

Subjects and methods. Data on 47 patients with metastatic renal cell carcinoma (mRCC) who received systemic (targeted) therapy in combination or after incomplete cytoreduction (iCR) were analyzed in this retrospective study. The proportion of men and women was 72.3 % and 27.7 %, respectively; their ratio was 2.6:1. All the patients (100%) underwent surgical treatment as nephrectomy or kidney resection for primary tumor. In the patients who had received radical treatment in different periods, the median relapse-free survival was 25.3 (0-187) months; the mean follow-up duration in the study was 33.2 (27.4–39.0) months. Out of the histological characteristics of a primary tumor, its Fuhrman grade was studied. Prior to initiation of mRCC therapy, Memorial Sloan Kettering Cancer Center (MSKCC) prognosis groups were assessed; the patients were divided into good (n = 9 (19.1 %)), interim (n = 28 (59.6 %)), and bad (n = 10 (21.3 %)) prognosis groups. Their total somatic status was separately rated using the ECOG scale: 0, (n = 10 (21.3%)), 1 (n = 24 (51.1 %)), and 2, (n = 13 (27.6 %)). The sites of metastases were as follows: the lung (n = 29), bones (n = 18), adrenals (n = 11), recurrence in the removed kidney bed (n = 10), and liver (n = 10). Multiple organ involvements were detected in 22 (46.8 %) patients. There were more than 5 metastases in one organ in 18 (40.0 %) patients and only 15 (33.3 %) were found to have a single focus in one organ. Whether iCR might be used as a separate line treatment was studied. A comparative analysis was made between 2 groups of patients with mRCC: 1) 20 patients who underwent iCR and 2) 27 patients who received systemic therapy (immunotherapy (n = 12), sorafenib (n = 8), and sunitinib (n = 7)). The control points were estimation of overall survival (OS), optimal indications for iCR in patients with mRCC, and time to progression (TTP) during first- and second-line systemic treatment.

Resuts. The median OS duration in Group 1 was longer: 46 months versus 31 months (p = 0.09). TTP was comparable: 9 and 6 months, respectively. Comparison of first-line systemic treatment showed that the median TTP was twice longer (13 and 17 months in the targeted (sorafenib and sunitinib) therapy group than that in the cytokine therapy group (6 months) (p = 0.0174). TTP during second-line therapy was 10 months. Median OS after immunotherapy, sorafenib and sunitinib therapy demonstrated no differences and was 34.2, 36.5, and 39.2 months (р = 0.8). 

Conclusion. This investigation suggests that the comprehensive approach in effective in treating mRCC. iRC may be used as an individual treatment in a certain patient group. However, survival rates in the examined group of patients can be increased only when targeted drugs are necessarily used in both first- and second-line treatment regimens. In spite of the metastatic pattern of RCC, the treatment algorithm for these patients should estimate the possibilities of using palliative cytoreductive treatment since its use may provide a median TTP of as many as 9 months. Just the same, over 30-month survival rates may be obtained when the latter is used in combination with systemic treatment.

A prospective study was conducted to assess the prognostic value of FGFR3 gene mutation status in patients with non-muscle invasive bladder cancer. A total of 265 patients were included in the study. FGFR3 gene mutations were found in 168 (63.4 %) cases. FGFR3 mutation rate was significantly higher in low-grade tumors (p = 0.00 004). With a median follow-up of 34 months hazard ratio of progression in FGFR3 mutant cases compared to FGFR3 wild type was 0.50 (95 % CI 0.17–1.49; p = 0.21). In the subgroup analysis, it was found that FGFR3 mutations in patients with T1 high grade tumors (n = 41) were associated with a significantly better prognosis: 3-year progression-free survival (PFS) in FGFR3 mutant cases (n = 17) was 100 % compared to 71.2 % (95 % CI 42.8–99.6 %) in the absence of mutations (n = 24). For other subgroups (Ta, T1 low grade) no statistically significant difference in PFS by FGFR3 mutation status was noted.

Objectives. To evaluate peri- and postoperative morbidity and functional results of LRC in a single-site cohort of patients, comparing it with standard open approach (ORC) and laparoscopic cystectomy with open urinary diversion (HALRC).

Subjects and methods. A prospective analysis was performed in 51 muscle-invasive and locally advanced BCa patients who underwent RC between February 2012 and March 2014 in N. N. Petrov Research Institute of Oncology, Saint-Petersburg. The final cohort included 21 ORC, 21 LRC and 9 HALRC patients. Mean patients age was 64 (38–81) years old and did not differ in all groups. Pathological stage were similar in all groups. Multivariable logistic and median regression was performed to evaluate operating time, perioperative and postoperative complications (30-d and 90-d), readmission rates, length of stay (LOS) – totally and in ICU.

Results. Operating time during LRC and HALRC was longer than that of ORC (398 min vs 468 min vs 243 min, respectively). Despite that, there was no statistically significant influence of type of surgery on intraoperative complications – 14.3 % in ORC group, 11.1 % in HALRC and 4.7 % in LRC patients. Major complication rates (Clavien grade  3; 23.8 % vs 33.3 % vs 19.4 %) were similar between all groups. However, LRC had 4,0 times lower rate of minor complications (Clavien grade 1–2) compared to ORC (4.7 % vs 19.0 %). LRC had a significantly shorter LOS (27.8 d vs 32.6 d vs 22.6 d in ORC, HALRC and LRC groups, respectively), but no significant differences in ICU stay existed (5.1 d vs 3.1 d vs 2.1 d). Morbidity were present by one patient in each group (medium rate 5,8 %). The common transfusion rate during and after surgical intervention was 19.6 % and was higher in ORC group (33.3 % vs 4.7 % in LRC); as well, intraoperative bleeding was lower in minimally invasive techniques – the average volume of blood loss was 285 ml in LRC and did not differ between HALRC and ORC groups – 468 and 577 ml, respectively. Depending on the timing of complications, there were 30-d complications in 19 patients (37,2 %) and 90-d in 27 (52,9 %). The greatest difference was observed between any grade gastrointectinal complications (foremost, ileus) with significantly better outcomes in LRC patients – 14.2 %, compared with 47.6 % and 55 % in ORC and HALRC, respectively.

Conclusions. We found that LRC is safe and associated with lower blood loss, decreased postoperative ileus and lower LOS compared with ORC. Using a population-based cohort, we found that laparoscopic surgery for bladder cancer decreased minor complications (mainly due to lower bleeding and gastrointestinal complication rate) and had no impact on major complications.

Objective. To evaluate the diagnostic impact of 11C–Choline PET / CT in the detection of recurrent prostate cancer (PCa) in patients with biochemical relapse after radical prostatectomy and to assess the correlation between PSA levels and PET / CT detection rate of PCa relapse.

Subjects and methods. 85 patients with biochemical relapse (mean PSA 3.51 ± 3.87 ng / ml) after radical prostatectomy (n = 64) and radiotherapy (n = 21) underwent 11C–Choline PET / CT. According to PSA level, patients were divided into three groups:  2 ng / ml, 2 to 9 ng / ml and > 9 ng / ml.

Results. Overall, 11C–Choline PET / CT detected PCa relapse in 33 of 85 patients (39 %). The mean PSA value in PET-positive patients was 5.78 ± 4.95 (0.22–17.80) ng / ml, while in PET-negative patients – 1.43 ± 1.08 (0.28–4.57) ng / ml. Positive PET / CT results were obtained in 9 of 40 patients (22 %) with PSA of < 2 ng / ml, in 17 of 38 patients (45 %) with PSA of 2 to 9 ng / ml, and in 7 of 7 patients (100 %) with PSA of > 9 ng / ml. Local relapse was detected in 42 % (14 / 33) patients. Both local and distant metastases were diagnosed in 39 % (13 / 33) cases. Distant relapse
was identified in 19 % (6 / 33) cases. PET / CT allowed to assess the efficacy of treatment in 26 % (12 / 47) PET-negative patients under hormone therapy at the scan time. However, PET / CT wasn’t able to localize the site of PCa recurrence in these hormone-ensitive patients what might have affected the overall detection rate.

Conclusion. 1) 11C–Choline PET / CT was able to detect and correctly identify the site of PCa relapse in 39 % cases and therefore was useful in determining the further therapeutic approach. 2) Our data confirmed the strong correlation between PSA levels and 11C–Choline PET / CT detection rate of PCa relapse (r = 0.9; p < 0.001). 3) 11C–Choline PET / CT has limited utility in localizing the site of PCa recurrence in some patients under hormone therapy.

Objective – to assess the clinical and prognostic values of the cystostomy in patients with prostate cancer after hormonal or combined (ADT + radiation therapy) treatment.

Materials and methods. In the study included 185 prostate cancer patients with cystostomy. In all cases patients was treat hormonal
or ADT + radiation. The dependence of frequency cystostomy from baseline characteristics of the tumor was assessed. The effect of cystostomy also were compared with survival rates in patients depending on the tumor process.

Results. It was found that the frequency cystostomy in patients with prostate cancer significantly increases with the volume of the prostate, and the clinical tumor category, Gleason score do not have significant effect on the frequency of cystostomy. The enhancement of overall survivance in patients with generalized prostate cancer was founded in case of cystostomy removed. There was no significant differences in overall survivance rates in patients with localized and locally advanced prostate cancer after hormonal and hormonoradiation treatment.

The high incidence of prostate cancer (PC) and the considerably wide use of hormone therapy for its treatment as an individual modality
for its advanced forms (Т3–Т4, N1, M1), recurrences, and progression after local treatments (radical prostatectomy, radiation therapy) and for combined treatment as neoadjuvant and adjuvant therapies determine the importance of a sufficient range of hormonal drugs at an urologic oncologist’s disposal. Among the luteinizing hormone-releasing hormone (LHRH) agonists, there is rather long-known Buserelin made in Russia, the clinical efficacy of which is highly competitive with foreign analogs. The paper presents the results of a 3-month trial of the efficiency and safety of Buserelin depot treatment in 20 patients aged 53 to 87 years with morphologically verified PC. The patients with PC showed a gradual decrease in the mean values of prostate-specific antigen (PCA) from
81.2 to 27.8 and 23.0 ng / ml at 2 and 3 months of Buserelin depot therapy, respectively. The performed therapy could achieve reductions in testosterone levels from 168 ng / dl at baseline to 21 and 19.8 ng / dl postcastration at 1 and 3 months of the therapy.
All the patients tolerated Buserelin depot therapy without having clinically significant adverse reactions. The most common complaints were hyperhidrosis and hot flushes, which are typical of all LHRH agonists and which are not marked in the treatment with other drugs of this group.

Conclusion. Buserelin depot 3.75 mg is a highly effective Russian drug to treat hormone-dependent PC. Its administration causes a reduction in PSA levels and ensures a steady decline in serum testosterone concentrations to the postcastration level without causing serious side effects. The findings do not differ from those when foreign LHRH analogues are used.

The paper reviews the current possibilities of cytostatic chemotherapy in patients with metastatic prostate cancer. It gives the data of studies dealing with the early use of docetaxel in patents with hormone-susceptible tumors and analyzes approaches to sequential therapy with docetaxel, cabazitaxel, and antiandrogens (abiraterone, enzalutamide) in patients with castration-refractory prostate cancer. Assessment of the prognostic role of different clinical and biological factors could provide an algorithm for the choice of first- and second-line therapy in patients with castration resistance.

We report the case of advanced clear cell renal cell carcinoma with brain, pulmonary, hepatic and bone metastases treated with pazopanib.
We observed the complete response in brain metastases and stable extracranial disease after 4 years of the treatment. According to the literature review this is the first reported case of complete response to pazopanib in brain metastases in renal cell carcinoma.

Prostate cancer (PC), like most cancers, belongs to multifactorial diseases arising from an interaction between environmental factors and
an individual’s genotype. The paper reviews the literature on the genetic predisposition to PC, which is determined by both rare gene mutations with high penetrance and inherited polymorphic genetic variants with low penetrance. The paper considers the clinical aspects of genetic predisposition to PC, among other factors, the need for male screening for both types of genetic abnormalities to assess the risk of this cancer.