Background. Restoring the quality of life of patients to a level comparable to that of practically healthy people is the most important task of medicine in general. At this stage of development of science, the main goal in the treatment of malignant diseases remains the preservation of life. However, now in oncological practice, methods whose potential allows not only to preserve life as such, but also to ensure the high quality of this life in all its manifestations, are acquiring greater and greater significance.

The objective of the study is to compare the quality of life of persons with localized kidney cancer in the early and late periods after surgical treatment by radical nephroectomy and laparoscopic resection of renal tissue.

Materials and methods. A questionnaire survey using SF-36 (Short Form-36), designed for a comprehensive assessment of the quality of life associated with health.

Results. The quality of life of patients with localized kidney cancer before treatment is reduced due to a number of physical and mental nature, limiting labor, domestic and social activity and causing a feeling of dissatisfaction with their lives in general. These problems are disorders of physical, social and emotional functioning, physical pain, deterioration of general and mental health, limitations of role functioning due to physical and emotional state. After surgical treatment with laparoscopic resection, complete satisfaction of patients with the quality of their life was achieved during the first 1–3 postoperative months; after radical nephroectomy – not earlier than 1–3 years.

Conclusion. One of the advantages of laparoscopic resection over radical nephroectomy is a higher quality of life of patients in the early and late periods after the intervention.

The study objective is to evaluate the effectiveness of preoperative targeted therapy, spectrum and rate of adverse events, as well as quality of life in patients with bone metastases of renal cell carcinoma.

Materials and methods. The study was conducted at the Research Institute of Oncology, Tomsk Medical Research Center between 2014 and 2018. The study included 34 patients with bone metastases of renal cell carcinoma who received preoperative targeted therapy with pazopanib for 8 weeks. All patients underwent surgical treatment of both the primary tumor and bone metastases.

Results and conclusion. It was shown that preoperative targeted therapy is characterized by a high rate of clinical response and satisfactory tolerability. In some cases, preoperative targeted therapy improves the conditions for surgical treatment of metastatic bone lesions, decreases intraoperative blood loss, decreases the volume and duration of surgical intervention, which, in turn, allows to preserve bigger range of motion in the affected bone segment and improve patients’ quality of life.

Background. We have previously described an algorithm APhiGT (Age, Prostate Health index, Gleason score, TNM stage) for staging of prostate cancer (PC) before treatment. The algorithm was developed by logistic regression on an educational selection (ES) of 337 PC cases. The algorithm includes data about the age of patients, the levels of total prostate-specific antigen (PSA), free PSA, [-2]proPSA and the ranked data of the Gleason score (by biopsy results) and T (by TNM).

Objective. Validation of APhiGT on the validation selection (VS) of 83 PC cases was carried out in this work.

Materials and methods. ROC analysis was performed in ES and VS.

Results and сonclusion. It is established that area under the curve (AUC), characterizing the ability to divide clinically significant subgroups of patients (Gleason score <7 vs. Gleason score ≥7, рТ2 vs. рТ3, localized indolent PC vs. localized aggressive PC) for APhiGT both in ES and VS was significantly higher than AUC for total PSA, %[-2]proPSA in free PSA and prostate health index. At the same time, in all clinical subgroups of patients AUC for VS was lower than AUC for ES, which may be due to a significantly smaller size of VS compared to ES.

Background. Extraperitoneal radical prostatectomy (RP) in patients with prostate cancer is useful when there are no oncological indications to lymph node dissection (e.g. in low and intermediate-low risk of the disease), and allows to perform precise anastomosis and facilitates the early postoperative period. However, even minimally invasive approach does not avoid such factors as a urinary catheter that may disturb patients.

Objective. We assessed the possibility to remove the urinary catheter as early as possible.

Materials and methods. 28 patients with low (n = 22) and low-intermediate (n = 6) prostate cancer risk (according to NCCN (National Comprehensive Cancer Network) criteria) underwent an extraperitoneal laparoscopic RP from March 2017 to November 2018. All operations were performed by the same surgeon (A. Nosov). The inclusion criteria were the following: localized prostate cancer, prostate specific antigen (PSA) <10 ng/ml, ISUP group 1–2, life expectancy of more than 10 years and preoperative patient’s counseling (awareness about early catheter removal and discharge). All patients were continent before surgery. During surgery, the prostate and seminal vesicles were removed extraperitoneally without peritoneal cavity opening and conversion. Bladder neck sparing was performed in all cases but nerve-vascular bundles were spared according to indication (preoperative International Index of Erectile Function (IIEF), oncological reasons). Vesicourethral anastomosis was performed by two V-Loc circular sutures. No drainage tubes were inserted to control bleeding/urinary leakage. A urinary catheter Foley 20 Fr was inserted into the bladder after anastomosis completion. No other urinary drainage (suprapubic tubes, etc) was used. Anastomosis resistance and completeness were checked at the end of surgery by filling the bladder with 150 ml of saline through the catheter. Except for cases with macroscopic hematuria, urinary catheters were removed on the 1st postoperative day’s morning (<24 hours) with an active followup (daily voiding assessment, pelvic ultrasound and postvoided residual volume assessment) on Day 1. Immediately after the catheter removal, alpha-blockers (for urination alleviation) and PDE-5 inhibitors (in patients with neurovascular sparing) were prescribed. All patients were available for a 3-month follow-up. During the follow-up, a monthly combined assessment was performed, including IPSS, QoL, PSA analysis, pelvic ultrasound and urofloumetry.

Results. The average patient’s age was 63 years (52–71 years). The median preoperative PSA level was 7.6 ng/ml. The intraoperative technique was unremarkable with no blood transfusion or conversion. All early postoperative complications were classified as minor – grade I, II and IIIa in 2 (7.2 %), 5 (17.8 %) and 1 (3.6 %) patients, respectively. Related to the early catheter removal complications included 1 (3.6 %) patient with urinary leakage (resolved by repeated prolonged urinary catheter insertion) and 4 (14.3 %) with urinary obstruction – resolved by single catheterization (n = 2), percutaneous suprapubic cystostomy (n = 2). No major complications were noticed during the follow-up. Totally, 22 (78.6 %) patients were discharged on the next day after the catheter removal – on the 2nd postoperative day. All discharged patients did not need readmission during the follow-up. Remained 6 (21.4 %) patients stayed at the hospital for 5–18 days. The pathological investigation showed upgrading in 9 (32.1 %) patients with low risk and in 1 (3.6 %) patient with low-intermediate risk. Upstaging to locally advanced forms was noticed in 6 (21.4 %) patients. All patients had the PSA level of <0.2 ng/ml 30–90 days after surgery. Postoperative assessment showed improvement in urinary function and erectile function sparing in selected patients, with no compromising functional results due to the early catheter removal.

Conclusion. Despite the common widespread of minimally invasive RP, there is no consensus on the terms of a urinary catheter removal. According to our data, we suggested it might be of some benefit to remove a urinary catheter early in selected and well-informed patients. A thorough vesicourethral anastomosis pursuance, nerve-sparing, bladder neck sparing and Retzius sparing procedure, intraand postoperative assessment is necessary in all cases.

The study objective is to determine advisability of radiation therapy in patients with recurrent prostate cancer after radical prostatectomy.

Materials and methods. In our research 92 patients were treated by salvage radiation therapy after radical prostatectomy. The median of follow up is 48 months.

Results. The rates of 1, 2 and 3 years disease-free survival were 96, 91 and 86 %. We received that prostate specific antigen doubling time <6 months and prostate specific antigen >0.5 ng/ml before salvage radiation therapy statistical significance associated with biochemical failure. The results of our study indicate two main negative factors in the prognosis of the efficacy of radiotherapy and combined hormone therapy in patients with biochemical or clinical locoregional recurrence – the period of prostate specific antigen doubling time less than 6 months (p = 0.035) after radical prostatectomy and a higher prostate specific antigen level, especially more than 0.5 ng/ml before salvage radiotherapy (p = 0.037).

Conclusion. Taking into account the absence of differences in the results of treatment between groups of patients with clinical and biochemical recurrences, it is not advisable to postpone the implementation of salvage radiotherapy and recommend patients to repeat the study. Repeated studies of these patients, as a rule, are conducted after many months at a higher level of the prostate specific antigen, which is associated with a higher tumor activity and a worse prognosis of the disease.

Objective: at the primary analysis of prostate cancer treatment referring to the patients who have experienced high dose rate brachytherapy after a confirmed locally recurrent tumor having been treated with diverse treatment modes.

Materials and methods. The research includes 28 patients aged 53 to 78 years old (average age is 66 years old) with histologically verified prostate cancer recurrence. Within the period 2015–2017 all the patients got a salvage high dose rate brachytherapy in the Russian Scientific Center of Roentgenradiology. Brachytherapy was carried out as 2 fractions with the single tumor dose of 12.5 Gy. There was a two-week gap between fractions with the total tumor dose of 25 Gy. The follow-up period is 9 to 36 months.

Results and conclusion. Overall biochemical free survival rate is 82.1 %. There are 5 people having a growing prostatic specific antigen (PSA) while the case follow-up. There is 1 case of a confirmed local tumor recurrence. Significant factors of the disease progression after salvage brachytherapy are: risk group, pretreatment PSA high, time line from the background therapy to biochemical recurrence uprise and PSA level if there’s prostate cancer recurrence after the background therapy.

Background. The average annual increment (5,09 %) of the prostate cancer (PC) incidence was highest across male oncological diseases registered in Russia from 2007 to 2017. 4643 new cases of PC were diagnosed in Moscow in 2017. As of 1st January 2018, the total number of living males with PC registered within Moscow healthcare system was 31,567.

The study objective was to obtain the structure of factual costs related to medicine therapy of PC covered by the budget funds of the Moscow Healthcare Department in 2016–2017, that would help to further improve the system of subsidized drug provision for Moscow residents.

Materials and methods. Using data from the information database of the Center for Medicine Provision of the Moscow City Department of Healthcare the following parameters were determined: total sum of expenses on drug purchase, mean treatment cost per 1 patient, number of patients receiving therapy, number of prescriptions, number of prescribed drug packs, mean pack cost, and others. The analyzed medicines were classified based on pharmacological and clinical groups. Costs for each class of therapies were studied.

Results. During studied period (2016–2017), the most funds in Moscow were spent on abiraterone and goserelin. In 2016–2017, the amounts of prescribed packs were highest for androgen deprivation therapy: luteinizing hormone-releasing hormone agonists – goserelin and buserelin. In the group comprising 10 therapeutic regimens associated with highest costs, the percentages of costs for hormonal therapy and chemotherapy were respectively as following: 80 % and 16 % in 2016 and 75 % and 23 % in 2017. In the simplified model of costs associated with androgen deprivation therapy and treatment of metastatic castration-resistant PC without consideration of androgen deprivation therapy constituted 39 % and 61 % in 2016 and 36 % and 64 % in 2017. In the population of patients with prostate cancer, zoledronic acid, abiraterone, docetaxel, cabazitaxel were the most used medications in 2017 and the rate of enzalutamide usage was lowest.

Conclusion. The highest costs are associated with treatment of metastatic castration-resistant PC. There is a growing necessity for improvement of funds spending on medications for patients with castration-resistant PC. This improvement could be achieved through development of medical methodologies that facilitate the selection of the most cost-effective approaches for early diagnosis and treatment.

Background. Enzalutamide and abiraterone are hormonal antineoplastic drugs used for treatment of metastatic castration-resistant prostate cancer (mCRPC). Both drugs were proved to be effective in randomized controlled trials.

Objective. Pharmacoeconomic analysis of using enzalutamide and abiraterone for treatment of chemotherapy-naive patients with mCRPC from the perspective of Russian healthcare system in 2019.

Materials and methods. We proposed a Markov model of mCRPC progression on three treatment options: enzalutamide, abiraterone or active monitoring with no antineoplastic treatment in the 1st line setting. The model was based on indirect treatment comparison of considered drugs. Modelling period was 5 years. The model was used for calculating per patient medical costs, and further cost–effectiveness, cost–utility and budget impact analysis.

Results. Monthly medication costs of enzalutamide were 183 551 rubles, which were 23 766 rubles (11.5 %) less than for abiraterone (207 224 rubles). 5-year total medical costs for enzalutamide were 5633 thousand rubles per patient, that were 67 499 rubles (1.2 %) less than for abiraterone. Incremental cost/effectiveness ratio for enzalutamide vs active monitoring was 533 thousand rubles per one life-month gained, compared to 623 thousand rubles per one life-month gained for abiraterone. If 7328 mCRPC chemotherapy-naive patients receive enzalutamide, Russian government healthcare spending will be 495 million rubles (1.2 %) less, compared to abiraterone.

Conclusion. With comparable costs enzalutamide is a cost-effective treatment option of chemotherapy-naive mCRPC patients, compared to abiraterone, in Russia.

Use of immunotherapy in treatment of muscle-invasive bladder cancer remains the most promising method in case of impossibility of chemotherapy with cisplatin or progression during cisplatin treatment. This approach is the method of choice and can prolong patient’s life. In particular, use of checkpoint inhibitors allows to obtain effective treatment of bladder cancer. However, to prescribe immunotherapeutic medication, patient must have point of application for these drugs. Individualized approach will allow to increase treatment effectiveness and disease prognosis while maximally improving the quality of life.

Most often, neuroendocrine carcinoma (NEC) is found in the gastrointestinal tract, broncho-pulmonary system, but they can also occur in other organs, such as the kidney, bladder, which is of most interest because of the rarity of this pathology. Until recently, there was not even a proper morphological classification for kidney NEC, and among some histological types, such as large cell neuroendocrine carcinoma of the kidney, only about 7 cases were recorded, and independent bladder carcinoids, about 15 cases. Currently, there are no clinical and morphological features of the NEC of the kidney and bladder, fundamentally distinguishing them from other neuroendocrine tumors and “classic” cancer of the same localization. This article also provides the data of the N.N. Blokhin National Medical Research Centre of Oncology on the incidence of all malignant neoplasms of the urinary system.

In Russia, approaches to treatment of castration-resistant prostate cancer include chemotherapy (docetaxel, cabazitaxel), androgen signaling inhibitors (abiraterone, enzalutamide) and systemic alpha-radiotherapy (radium-223 dichloride). Radium-223 is a radioactive calcium mimetic which selectively accumulates in bone tissue affected by metastases. In the registration study it was shown that radium-223 significantly increases overall survival and time to first skeletal complication in castration-resistant prostate cancer patients with symptomatic metastases in bones and without visceral metastases. The review objective is to determine the profile of patients who can get the most prominent benefits from systemic radiotherapy, as well as to identify the optimal placement of radium-223 in the sequence of therapeutic agents used for prostate cancer treatment.

The study objective is to analyze incidence of cancer morbidity and morality in Russia and some former Soviet states. Prevalence of urinary and male urogenital organs cancer continues to grow. Morphological verification of the diagnosis varied from 58.5 % (at bladder cancer in Tajikistan) up to 93.7 % (in Russia), at a prostate cancer the maximum values are registered in Russia, Belarus and Ukraine (91–99 %); at kidney cancer in Russia, Belarus and Uzbekistan (84 %). In 2012–2017 years the increase of kidney cancer incidence in Russia (in men) made 13.8 %; at a prostate cancer, growth of the standardized rates is registered in all provided countries of the former USSR (except Kyrgyzstan). Decrease in incidence rates of bladder cancer is registered at men in Belarus, Moldova, Kazakhstan, Armenia and Kyrgyzstan. In Russia and Belarus mortality rates of kidney and a bladder cancer decreased; at a prostate mortality rate for the 5 anniversary is stable in Belarus; its insignificant increase was in Russia (for 3.4 %). The increase of penis cancer incidence in Russia was 24 %. The ratio of the maximum and minimum incidence rates among regions of Russia reached 16-fold sizes (at penis cancer) and 6-fold sizes – at testis tumours. Above, than on average in Russia (2.1 per 100 thousand, male population) testis cancer cases in Belarus (3.0 per 100 thousand). In 2012–2017 the increase of testis cancer incidence in Russia was 16.7 %.

Background. Despite significount successes in treatment of rhabdomyosarcoma of urogenital system in children there are unresolved questions of choise of optimal chemotherapys combinations, intensity of chemotherapy, volumes and terms of radiotherapy, tactics of treatment residual tumors in last 3 decades.

The objective: show 15 years experience of treatment local and locally prevalent rhabdomyosarcoma urogenital system in children. The prognosis for children and adolescents with rhabdomyosarcoma has improved with refinements in multi-modal therapy.

Materials and methods. In reseach are included 86 patients with a median age of 8.4 (0.7–17) with a local genitourinary rhabdomyosarcoma, treated in N.N. Blokhin National Medical Research Centre of Oncology from 2000 to 2016. All patients were treated in different riskadopted clinical protocol included chemotherapy and radiotherapy (IRS, SIOP, CWS and local protocol DORMS-6).

Results. A 10-year overall survival and disease-free survival rates were 76 and 72 % in the entire group rhabdomyosarcoma patients, respectively.

Conclusion. The effectiveness of the risk-adopted strategy in the genitourinary rhabdomyosarcoma treatment as well as the need of new approaches and in the cases of residual viable tumor after induction chemotherapy was demonstrated.

Background. In recent years, we observe technological and scientific growth in the field of medicine. It makes revise of existing ideas about certain pathological conditions. Such a serious complication of radiation treatment as fistulas of the pelvic organs is not excluded. All available classification of the post radiation fistulas of pelvic organs or consider them in the total mass of fistulas, specifying only the cause of occurrence, or even fall into the category of “others”. Moreover, the existing classifications do not reflect the medical tactics needed in each particular case.

The study objective is to develop classification of radiation-induced fistulas of the lower pelvis which would assist with selection of the optimal treatment tactics.

Materials and methods. This study analyzed the results of the examination and treatment of 82 cases of post-radiation pelvic fistula.

Results and conclusion. Treatment of patients according to the proposed classification allowed to attain stable recovery in 92 % of cases.

From 15th to 19th of March, 2019 in Barcelona was held the 34th Annual Congress of the European Association of Urology (EAU), which was attended by about 15,000 doctors from more than 120 countries. The first eau Congress was held in Padua (Italy) in 1974, it was attended by only 100 doctors. About 4,500 abstracts were sent to the Congress in Barcelona, about 1,200 of which were approved in the form of reports and poster sessions. Oncourological subjects accounted for almost half of all accepted theses. The article is devoted to the review of the most significant reports presented at the EAU Congress of 2019 on oncourological diseases.