Over 200,000 new cases of renal-cell carcinoma (RCC) are notified worldwide every year. Examinations diagnose metastatic RCC (mRCC) in 25 % of primary patients; and after radical surgery 20–40 % of the patients are further diagnosed with disease progression and metastases. Randomized trials have demonstrated the efficacy of tyrosine kinase inhibitors in treating mRCC. Clinical trials are conducted on a carefully selected population of patients; the latter have generally clear-cell RCC without brain metastases and a good somatic status. In real clinical practice, the population of patients with mRCC is more heterogeneous; there are patients with non-clear cell mRCC, brain metastases, and an ECOG somatic status > 1; this raises the question as to whether it is effective and appropriate to use target agents in these patient groups.

The paper gives the data of performed clinical trials using sunitinib with expanded inclusion criteria and those of non-randomized trials that have proven the clinical efficacy of the drug in patients with a poor prognosis, non-clear cell mRCC, and brain metastases, as well as in the elderly. Despite lower objective response rates, the progression-free survival rates in this category of patients have proven to be comparable to those in patients with clear cell mRCC.

The purpose of our study was to assess the interobserver variability in tumor stage and grade in patients with non-muscle invasive transitional cell bladder cancer. The prognostic relevance of grade and stage from both the initial and review diagnosis were determined. Pathological slides from 154 superficial bladder carcinomas were reviewed. Progression-free survival and hazard ratios for each stage and grade were calculated with Kaplan-Meyer method and Cox proportional model. There were significant interobserver differences in both the grading and staging of tumours. In pathology review overgrading was more frequent than undergrading, pathology review downstaged T category to stage Ta in 60,0 % of cases originally classified as stage T1.

Objective: to investigate survival in patients with bladder cancer (BC) after radical cystectomy (RCE).

Subjects and methods. Our clinic performed RCE using different urine derivations in 375 patients with BC. There were 324 (86.4%) men and 51 (13.6%) women. All the patients underwent clinical, laboratory, ultrasound, X-ray, and radiation studies.

Results. The 10-year overall and cancer-specific survival rates were 43.4 and 47.2%, respectively. In patients without regional lymph node (LN) metastases, the 2- and 3-year overall survival rates were 81.2 and 67.2%. In those with regional LN metastases, the 2- and 5-year overall survival rates were 46.9 and 13.9%. In the negative LN group, the 2- and 5-year cancer-specific survival rates were 83.6% and 70.7%, respectively. In the positive LN group, these were 51.0 and 15.1%. The overall and cancer-specific survival rates also declined with higher tumor stage and grade.

Conclusion. Tumor stage, regional LN metastases, and histopathological grade have a considerable independent impact on the overall and cancer-specific survival rates of patients with BC following RCE.

Objective: to study the late results and quality of life in women after pelvic exenteration.

Subjects and methods. The late results of surgery and quality of life were studied using the SF-36 questionnaire in 45 women with bladder cancer and in 47 with cervical cancer at follow-ups of 3-104 months (median 51 months) after pelvic exenteration.

Results. The five-year overall and relapse-free survival rates were 60.9±15.8 and 55.4±12.6%, respectively. All quality of life indicators virtually improved as compared to preoperative data.

Conclusion. Pelvic exenteration at a reference center allows patients to achieve rather high survival rates and quality of life.

Background. Most of serious complications of radical cystectomy (RCE) should be associated with the comorbidity of patients and the interintestinal anastomoses designed with urinary reservoirs rather than with RCE. It is relevant to identify and assess the role of predictors for morbidity of RCE and urine derivation.

Objective: to search for risk factors for complications after RCE with different types of urine derivation.

Subjects and methods. The immediate and late results of RCE and urine derivation were studied in 350 patients with bladder cancer. Sequential postoperative complications were additionally analyzed in chronological order in all the patients, including non-cancer ones (n = 43).

Results. 43.9% of the patients had postoperative complications, if a surgeon had sufficient surgical experience; there was a preponderance of patients with mild-to-moderate complications (Clavien-Dindo grade I-II, 37.8%) unassociated with urine derivation. The patients with severe postoperative complications were 16.3%; mortality was 3.1%, which significantly correlated with surgical experience. Late (3-18 month) postoperative complications were detected in 21.4% of the patients with a preponderance of those with urine derivation-related complications (19.4). The frequency of complications due to extraintestinal versus intestinal urine derivations was significantly higher (68.1 and 49.8% (p < 0.05). During two-step surgical treatment, the patients demonstrated higher morbidity and worse survival. Extraintestinal urine derivations, continuous urinary intestinal diversion determine a less favorable prognosis compared with one-stage ortho- and heterotopic procedures. The type of urine derivation and the experience of a surgeon performing RCE are valid predictors for postoperative morbidity and independent prognostic factors of overall and cancer-specific survival, respectively. 150 operations are needed for achieving optimal surgical experience. Discussion. It is appropriate to increase the time of research reports on the results of urine derivation up to 12-18 months of a postoperative follow-up.

In practice, the routine use of two-step RCE and final urine derivation and internal and/or external urine ones should be abandoned; preference should be, when possible, given to single-stage ortho- and/or heterotopic urine derivations rather than to the former.

Conclusion. Extraintestinal (percutaneous puncture nephrostomy, ureterocutaneostomy), and internal (ureterosigmoanastomosis, ureterosigmorectoanastomosis, Mainz pouch II) urine derivations, two-step surgical treatment, and a surgeon’s insufficient experience are predictors for high morbidity and poor prognostic factors for survival after RCE and urine derivation.

The prostate cancer (PC) screening program elaborated in the Republic of Belarus, which envisages the determination of prostate-specific antigen (PSA) levels once every two years among 50–65-year-old men and 6-point lateralized transrectal ultrasound-guided biopsy at a PSA level of > 4.0 ng / ml, could rule out the probability of diagnosing clinically insignificant PC. Out of 20,786 male examinees, 249 (1.2 %) patients were found to have PC. Of them, 190 patients underwent D»Amico cancer risk stratification. A low-risk group included 11 (5.6 %) patients, for whom follow-up tactics might be selected; the other patients should receive appropriate treatment. Therefore, the problem of hyperdiagnosis is not relevant during the first PC screening round in Belarus and cannot constrain the further introduction of the screening program.

Prostate cancer is the most common men`s cancer in men in developed world and the second cause of death in this population. This review focuses on management of advanced castration resistant prostate cancer (CRPC) has been rapidly changing and is still evolving. In the last years, there has been an increasing knowledge of prostate cancer biology. New therapeutic agents and approaches have been evaluated demonstrating benefits in survival and quality of life in patients with metastatic prostate cancer.

Objective: to comparatively estimate the frequency of a positive surgical margin and 5-year biochemical recurrent-free survival (BRFS) rates in patients with locally advanced prostate cancer in relation to the time of radical retropubic prostatectomy.

Subjects and methods. The investigation enrolled 274 patients with prostate cancer (pT3-4N0-1M0) who were divided into 2 groups of 68 and 20 patients operated on in 1997 to 2006 and 2007 to 2012, respectively. Two surgeons made surgical interventions by the standardized procedure. The 5-year BRFS rates were estimated using the Kaplan-Meier method and log-rank test. A biochemical recurrence was defined as a prostatespecific antigen level of t 0.2 ng / ml in 2 consecutive measurements or as the initiation of adjuvant therapy.

Results. The detection rate of a positive surgical margin decreased from 55.9 % in 1997–2006 to 37.9 % in 2007–2012 (p = 0.01); the 5-year recurrence-free survival rates were 38.8 % versus 66.2 % (p < 0.001).

Conclusion. These changes would probably be a result of surgeons» better experience and improved surgical techniques in the course of time.

Prostate cancer (PC) preserves its leading position among male tumors. Ductal carcinoma is the second common type of prostate adenocarcinoma. The paper describes different types of ductal carcinoma, which have their morphological pattern. Ductal adenocarcinoma is a relatively rare morphological type of prostate adenocarcinoma traditionally regarded as a more aggressive type of PC, which is represented by the common forms with high Gleason scores (9, 10) and no well-defined treatment regimen. This paper describes 3 cases of ductal PC diagnosed at our center.

The experience with magnetic resonance imaging (MRI) used to diagnose prostate cancer (PC) is more than 35 years. Cardinal changes have occurred over that time. The accumulation of experience and the development of technologies have given rise to multiparameter MRI (mpMRI) involving the assessment of both functional and anatomic images. The International MRI Working Group on PC Diagnosis was set up in 2007. The Group has elaborated the basic principles of the standardization and compatibility of MRI studies, which are embodied in the European Society of Urogenital Radiology (ESUR) guidelines as a PI-RADS. The development of this system could create conditions for reducing variations in MRI procedures, interpretation, and mpMRI report forms for PC. The system has realized a scale of rating categories that summarize levels of suspicion or risk and that may be used to select patients for different tactics, such as biopsy or active monitoring. Furthermore, such an optimized approach allows reproducible MRI studies for monitoring during an active follow-up and for the early detection of recurrences. Therefore, PI-RADS enables one to systematize MRI reports and to unify the language of communication between radiologists, urologists, and oncologists.

Owing to the rapid widespread and introduction of the PI-RADS system, it has become possible to analyze its efficiency and to reveal some critical moments. The pooling of the resources of the American College of Radiology (ACR), (ESUR), and the AdMetech Foundation has permitted an Ad Hoc Coordinating Committee, the activity of which is to obtain scientific evidence and to form expert opinions to improve the system, as a result of which an updated PI-RADSv2 was published in 2015. This paper deals with the basic principles of a prostate MRI analysis in accordance with the PI-RADSv2 grades.

Objective: to carry out a pharmacoeconomic analysis of using tyrosine kinase inhibitors for the targeted therapy of disseminated renal cell carcinoma.

Materials and methods. The data on the efficacy and safety of therapy with tyrosine kinase inhibitors were obtained from the analysis of the results of clinical trials selected during an information search. The pharmacoeconomic analysis used the following methods: cost analysis, budget impact analysis, cost miniminization analysis, and sensitivity analysis.

Results. The performed investigation demonstrated that the use of pazopanib in patients with disseminated renal cell carcinoma was expedient from an economic standpoint and less effective than that of sunitinib. The cost of an annual cycle of pazopanib treatment in Russia was not found to be greater than the payment readiness threshold. Analysis of the purchase amount of tyrosine kinase inhibitors for the treatment of renal cell carcinoma in 2014 demonstrated that the use of pazopanib could reduce government spending by 290.2 million (21.6%) rubles per year. This saving of budgetary funds provides a way of treating additional 375 people per 1,000 patients when using pazopanib. The administration of pazopanib with its existing purchase amount for the treatment of disseminated renal cell carcinoma will be able to reduce government spending by 1.4 milliard rubles during 5 years, which corresponds to the current annual costs of tyrosine kinase inhibitors.

Conclusion. The use of pazopanib makes it possible to reduce government spending on 1st line targeted therapy of advanced RCC in comparison with sunitinib with comparable efficacy of both agents.

The authors consider the prevalence, etiology, pathogenesis, symptoms, diagnosis, differential diagnosis, and surgical treatment of bladder endometriosis on the basis of 3 own cases and an analysis of 384 cases described in world literature. It has been established that endometriosis may mimic bladder carcinoma. The detection of the cyclic pattern of gross hematuria and other symptoms (during menstruation) and that of the characteristic type of tumorous endrometrioid mass at cystoscopy performed during or just prior to menstruation are of key importance for the differential diagnosis of endometriosis and carcinoma. Indications for open resection of the bladder, transurethral resection, and minimally invasive laparoscopic surgery are determined.

Schwannoma is a benign tumor that grows from the Schwann cells forming the myelin sheath of peripheral nerves. The clinical manifestations are nonspecific and generally due to compression of the adjacent structures of a growing tumor. The location of the tumor in the scrotum is rare; its primary diagnosis is difficult and only immunohistochemical examination allows the final diagnosis to be established. The authors present a clinical case of a patient operated on at the Urology Department, Moscow Clinical Research Center, for intrascrotal schwannoma causing impaired microcirculation in the scrotal skin to form purulent scrotal ulcers. In terms of the benign pattern and extratesticular localization of the tumor, its removal without orchifuniculectomy can yield a good clinical result.

The paper describes a rare case of synchronous bilateral tumor involvement of the urinary tract.