More than 35 years since the first deliberate nerve-sparing radical prostatectomy, this technique remains one of the main methods of treatment for patients with localized prostate cancer. Further study of operative anatomy of the lower pelvis and development of surgical technique facilitated evolution of approaches to nerve sparing. This review is dedicated to analysis of current approaches to preservation of neurovascular bundles in radical prostatectomy allowing to optimize functional results of surgical treatment of prostate cancer.

Disseminated renal cell carcinoma is an immunogenic tumor in which cytokine immunotherapy is usually used as the second-line treatment. It is associated with a low frequency of objective responses and short progression-free survival. Modern studies resulted in more effective treatment regimens based on new high-affinity TKI multikinases (cabozantinib, lenvatinib), as well as immuno-oncological drugs that can specifically block intercellular transmission of anti-immunogenic signal (PD-1 inhibitors) (nivolumab, pembrolizumab) or its ligand type 1 (PD-L1) (avelumab), antigen type 4 associated with anticytotoxic T-lymphocyte (ipilimumab)). Cabozantinib is a 2nd generation multikinase inhibitor that blocks the receptors of growth factors MET, AXL, and VEGFR-2, which are involved in tumorigenesis and responsible for resistance to traditional antiangiogenic therapy in renal cell carcinoma. Registration studies have shown that cabozantinib together with combined targeted therapy is more effective in patients with favorable and intermediate prognosis, while the PD-1 inhibitor (nivolumab) – in patients with poor and intermediate prognosis.

Objective: to analyze the results of cabozantinib studies and its possible use in the sequential treatment of disseminated renal cell carcinoma.

In the structure of oncological morbidity, renal cell carcinoma takes the 10th place among malignant neoplasms. The increase in incidence is observed from the age of 35–40 years and reaches a maximum at the age of 65–70 years. In terms of frequency of occurrence, clear cell renal cell carcinoma is ranked first among all kidney tumors. Meanwhile, due to the high heterogeneity of renal cell carcinomas with clear cytoplasm group, significant differential diagnostic difficulties arise in the morphological verification of these tumors. The article presents all nosological forms of kidney tumors with clear cytoplasm and provides a database of already known immunohistochemical markers for each nosological unit.

The last decades are characterized by an active search for highly sensitive and specific urinological and serological tumor-associated markers of renal cell carcinoma. This review analyses the results of studies of traditional serological tumor-associated markers and a potential new tumor-associated marker of renal cell carcinoma: kidney injury molecule-1, or KIM-1. The structure, sources and functions of KIM-1 in normal conditions and in damaged renal tubules, its potential role in carcinogenesis are described. The experience of using KIM-1 for specifying diagnosis of the most common histological types of renal cell carcinoma is analyzed. Data on KIM-1 expression in malignant tumors in other locations and non-oncological kidney disorders are presented. The role of KIM-1 in early diagnosis of nephrotoxic effect of antitumor drugs is described. The accumulated data is promising in regards to using KIM-1 in clinical oncology as a urinological and serological marker of renal cell carcinoma and chemotherapy nephrotoxicity.

Renal cell carcinoma (RCC) is one of the most common forms of malignant epithelial tumors of this localization. The development of new approaches to the diagnosis, prognosis and treatment of RCC is an topical issue of molecular medicine. The renin-angiotensin system (RAS) is not only an important component of the central and humoral mechanisms of controlling blood pressure and hydroelectrolytic balance, but also refers to the body systems involved in complex carcinogenesis pathways. Researches on the role of RAS in tumor progression are currently the priority. The data on the role of RAS in the development and progression of malignant tumors in the kidneys are being discussed. In this article, we present an overview of data on the role of RAS in the emergence and development of RCC, an analysis of the molecular mechanisms of development and progression of RCC, the prospects for using indicators of the RAS: angiotensin-converting enzymes (ACE), ACE2 and angiotensin II receptors as markers of diagnosis and monitoring of neoplastic transformation processes in the kidney. The prospects for the use of new, effective anticancer drugs with a targeted effect on definite indicators of the RAS of RCC were analyzed.

Objective: to evaluate alleles distribution of single nucleotide polymorphism 118A>G of μ1-opioid receptor (OPRM1) gene in patients with renal neoplasm and benign diseases.

Materials and methods. 100 consecutive patients after renal surgeries retrospectively divided into groups with neoplasm (n = 29) and benign diseases (n = 71).

Results. The incidence of renal neoplasm was much higher in homozygous 118A patients than in AG + GG group (36.4 % vs. 14.7 %; p = 0.035).

Conclusion. Single nucleotide polymorphism 118A>G OPRM1 gene may be of value in genesis of renal neoplasm.

The study objective: estimation of two group patients, treated in N.N. Petrov National Medical Research Center of Oncology with renal cell carcinoma.

Materials and methods. The 1st group include patients with standard postsurgical care management after open renal resection with lumbotomy access and warm renal ischemia. The 2nd group include the same treated patients with minimally invasive surgeries and fast track elements under induced hypotension. We analysed preparation of patient for surgery, differences in after treatment care management, frequencies and pain severity, after treatment complications, blood loss severity.

Results and conclusion. Research suggests that the system of enhanced recovery after renal resection ensure early patients rehabilitation with two-time less hospitalization period.

Objective: an assessment of efficacy and safety of lenvatinib in combination with everolimus in unselected patients with metastatic renal cell carcinoma (mRCC) progressed during or following ≥1 line of antiangiogenic targeted therapy.

Material. Russian multicenter observational study ROSLERCM included 73 consecutive patients with morphologically verified mRCC progressed during or following ≥1 line of antiangiogenic targeted therapy, treated with lenvatinib (18 mg/d) and everolimus (5 mg/d) in 20 Russian centers. Median age of the patients was 59 (23–73) years, a male-to-female ratio – 3:1. Most common histological type of kidney cancer was clear-cell RCC (71 (95.8 %)). More than 2 lines of previous therapy were administered in 45 (61.6 %) cases. Most patients were diagnosed with multiple metastases (71 (97.3 %)) in >1 site (61 (83.6 %)). Nephrectomy was performed in 87.7 % (64/73) of cases. At the combined therapy start ECOG PS 2–4 was registered in 16 (20.5 %), poor prognosis according to IMDC score – in 33 (45.2 %) patients. Median follow-up was 9.7 (1–26) months.

Results. Median progression-free survival achieved 16.9 (95 % confidence intervals (CI) 12.1–20.6), overall survival – 20.8 (95 % CI 15.7–25.9) months. Objective response rate was 11 % (8/73); tumor control was reached in 93.2 % (68/73) of cases. Median objective response duration was 10.5 (4.3–16.8) months, tumor control duration – 10.0 (2.5–17.5) months. Any adverse events developed in 83.6 % (61/73), adverse events grade III–V – in 23.3 % (17/73) of cases. Most frequent AE grade III–IV were diarrhea (10 (13.6 %)) and arterial hypertension (6 (8.2 %)). Unacceptable toxicity demanded treatment cancellation in 4.2 % (3/73), therapy interruption – in 30.1 % (22/73) and dose reduction – in 32.9 % (24/73) of patients.

Conclusion. Unselected mRCC patients administered with combined targeted therapy in the real world practice were registered with similar survival, lower objective response rate, and better tolerability comparing with population assigned for lenvatinib plus everolimus in the randomized phase II trial.

Background. Prostate cancer progression remains as a major problem among patients after their radical treatment. During last years a broad spectrum radiopharmaceuticals had developed to reveal the cause of biochemical recurrence.

Objective: the comparison of 18F-fluorocholine and 18F-prostate-specific membrane antigen-1007 (18F-PSMA-1007) diagnostic abilities for the prostate cancer progression detection.

Materials and methods. In this study had been included 18F-fluorocholine and 18F-PSMA-1007 PET/CT (positron emission tomography combined with computed tomography) scans of 9 patients after radical treatment with increased prostate-specific antigen (PSA) level (range 0.10–9.06 ng/ml).

Results. 18F-PSMA-1007-PET/CT detected lesions in 7 (77.8 %) out of 9 patients, after radical prostatectomy and brachytherapy, in comparison with negative 18F-fluorocholine-PET/CT results in all cases.

Conclusion. In this pilot study, 18F-PSMA-1007-PET/CT has showed high potential in pathological changes detection among patients with increased PSA level (minimum 0.10 ng/ml) and demonstrated the advantages in comparison with 18F-fluorocholine-PET/CT, especially in terms of revealing local recurrence and metastatic lymph nodes, as well as, in bone lesions early detection.

Background. In Russia in 2018, prostate cancer in 40.4 % of patients was detected in stages III–IV, which requires combined and complex treatment, including hormone therapy. In the course of treatment, the tumor inevitably acquires the features of castration resistance. Currently, there are several drugs for the treatment of metastatic castration-resistant prostate cancer (mCRPC), however, there are still no standards for the optimal drug choice in patients with mCRPC, data on adverse events, duration and quality of life of patients.

The study objective is describe treatment regimens for patients with mCRPC who are receiving chemotherapy/hormone therapy as the 1st and 2nd line of therapy, describe the characteristics of patients and diseases, justify the choice of therapy, describe the response of a tumor to the treatment, the types of disease progression during chemotherapy and hormone therapy, reasons for the discontinuation of treatment, treatment sequence, assessment of the overall and progression-free survival.

Materials and methods. The study included and analyzed 341 patients from 41 medical institutions in Russia. The total follow-up for each patient was up to 24 months, except of the cases of death of a patient or withdrawal from the observation.

Results. At the time of the initial diagnosis of prostate cancer in 198 patients (58.1 %) stage IV cancer was detected. The Gleason index of 8–10 points was determined in 118 (40.5 %) patients. The median prostatic specific antigen level (min–max) was 42.1 ng/ml (0.075– 11 743 ng/ml). Medical castration was underwent in 304 (89.1 %) patients. Duration of androgen deprivation therapy <6 months – 26 (7.6 %) patients, ≥6 months <24 months – 138 (40.5 %), ≥24 months – 142 (41.6 %), not performed – 33 (9.7 %). Localization of metastases to regional lymph nodes was detected in 101 (29.8 %) patients, bones – 293 (86.4 %), liver – 12 (3.5 %), lung – 24 (7.1 %), brain – 3 (0.9 %), other localizations – 29 (8.6 %). At the end of the observation period, 158/341 (46 %) of the patients were alive, 97/341 (28.4 %) patients died and 73/341 (21.4 %) of the patients were lost for follow-up. The results of treatment using 1st line therapy were evaluated in 317 patients. The treatment was interrupted in 163/317 (51.4 %) cases. The main reason for the cessation of treatment (131/163, 80.3 %) was the progression of the disease. The 2nd line therapy was started in 124 patients. Treatment using the 2nd line therapy was discontinued in 62 patients (50.8 %). The reason for the cessation of the treatment in 41 patients (68.3 %) was the progression of the disease, in 11 patients (17.7 %) – the decision of the patient, in 1 patient (1.6 %) – non-hematological toxicity, in 11 patients (17.7 %) – other reasons.

Conclusion. This study shows the epidemiological patterns of mCRPC, the approaches to treating the disease and the results in real clinical practice during the diagnosis and treatment of mCRPC in the Russian Federation. In the Russian patient’s population, the detection of prostate cancer remains at a high level in stage IV in which a patient has distant metastases (58.1 % of patients), while the high frequency of prostate cancer metastasis in bones is confirmed (86.4 % of patients). Long-term drug treatment of mCRPC is possible in the minority of patients, of all patients who start 1st line chemotherapy, the 2nd line of therapy is started only in 36.4 % of patients.

Currently, enzalutamide is the standard of pharmaceutical therapy of metastatic and non-metastatic castration-resistant prostate cancer. However, until recently there was no data on effectiveness and safety of enzalutamide in metastatic hormone-sensitive prostate cancer. Results of 2 large randomized clinical trials ARCHES and ENZAMET showed that early prescription of enzalutamide in combination with standard androgen deprivation therapy allows to significantly increase survival of patient with metastatic hormone-sensitive prostate cancer. The review describes data of these trials and advisability of prescribing enzalutamide in combination with androgen deprivation therapy as 1st line therapy of metastatic hormone-sensitive prostate cancer.

Objective: to comparе the safety and efficacy of the new method of en-bloc transurethral resection (TUR) and conventional TUR in management of primary non-muscle-invasive bladder cancer, and investigate long-term effects on tumour recurrence and progression.

Materials and methods. A total of 914 patients with primary non-muscle-invasive bladder cancer were treated using TUR of bladder at the Minsk City Clinical Oncologic Dispensary in 2005 to 2016. For final analysis the data was underwent many-stage random sampling. Randomization was stratified according to sex and age, category T, tumour grade, EORTC risk groups. In total, 273 patients were selected: 136 in the new method of en-bloc TUR group (a study group) and 137 in the conventional TUR group (a control group). The new method of en-bloc TUR is based on using impulses of high-frequency current applied to the active electrode of the resectoscope. The impulse sequence and individual impulse duration within the interval from 0.1 to 1 second are controlled in the course of the operation. Five-year follow-up data of operative management were analyzed.

Results. In event of the new method of en-bloc TUR there were no perioperative complications and no cases of conversion to conventional TUR. Postoperative complications were less frequently observed in the new method group compared with conventional TUR group. There were significant differences with major priority to the new method of en-bloc TUR in median time to recurrence (р = 0.032) and progression (р = 0.001), 5-year survival to recurrence (р = 0.0001) and progression (р = 0.001), 5-year cancer-specific survival (р = 0.033) and overall survival (р = 0.045) of patients.

Conclusion. The new method of en-bloc TUR of non-muscle-invasive bladder cancer was more effective than conventional TUR in reducing rates of intraand postoperative complications, and at the same time was applicable in all clinical cases, regardless of the tumor location in the bladder lumen, its size, vascularization, and growth pattern. The new method of en-bloc TUR also significantly improved the long-term cancer treatment results in patients with primary non-muscle-invasive bladder cancer.

The article presents 2 clinical examples of using a PD-L1 inhibitor atezolizumab in treatment of urothelial cancer. In the 1st clinical case of bladder cancer, due to concomitant pathology any platinum-containing therapy was impossible. After 9 months of treatment with atezolizumab target lesions decreased by 55 %, and the patient’s condition improved significantly: pain intensity decreased, dysuria frequency decreased, appetite became normal. In the 2 nd clinical case of urothelial cancer, complete response to therapy was achieved after 10 months of treatment. Pain intensity decreased significantly, dysuria was cured. Both patients continue atezolizumab immunotherapy without any adverse events. Therefore, use of up-to-date oncoimmunological medications has entered clinical practice and allows to achieve good therapeutic effect with high treatment safety.

Objective – the choice of tactics for the treatment of breast cancer in a kidney transplant recipient. The article presents a clinical case of a 51-year-old patient with a clinical diagnosis: left breast cancer IIA stage рТ2N0М0G3; triple-negative type. About chronic renal failure 10 years ago the patient was kidney transplantation was performed. The development of transplantation has expanded the use of immunosuppressive therapy in clinical practice. As a result, the risk the development of secondary tumors, including breast cancer, increases.

The article presents a complex clinical case of a patient with primary multiple cancer, with lesions of the prostate, bladder, ureter, stomach, regional and distant lymph nodes. Initially, it was assumed that there were four localizations of cancer, but after performing the operation and conducting thorough morphological and immunohistochemical studies, it became possible to prove that only two cancer localizations were present, namely prostate cancer and stomach cancer. The implementation of complex palliative (salvage) surgical interventions as the first stage of the complex treatment of prostate and bladder cancer, as well as the performance of simultaneous operations, can improve the prognosis of patient survival.