Purpose: to evaluate the efficacy and safety of selective arterial embolization in patients with tumors of the only kidney.

Materials and methods: in our clinic we performed embolization in 9 patients with median age of 56 years (range from 49 to 65 years) from 1999 to 2007. The tumor of the only kidney was diagnosed 1—27 years after (median time interval 11 years) contralateral nephrectomy performed for renal cell carcinoma (n=6), hydronephrosis (n=2) and cystic disease (n=1).

Maximal dimensions of tumor in the remnant kidney ranged from 2 to 9 cm (median 5,0±1,7 cm). Selective embolization of arteries feeding the tumor was carried out by polyvinyl-alcohol particles with diameter 0,1 mm, finely sliced haemostatic sponge, ethanol of 96° mixed with lipidol in 2 to 1 proportion, fragments of metallic spirals.

Results: no complications after selective arterial embolization were observed. After the procedure body temperature elevation up to 38° C and moderate pain syndrome in the projection of embolized kidney were seen for a short period of time. Insignificant elevation of serum urea and creatinine were registered in 2 of 9 patients.

In 1 month after embolization reduction of tumor volume was registered in 5 patients and stabilization — in 4 patients. During follow up angiography repeated embolization was carried out to 4 of 5 patients. At present 8 of 9 patients are alive with follow up times ranging from 1 to 7 years. One patient died after 7 month after procedure due to progression of disease.

Conclusion: selective arterial embolization is effective and safe modality of treatment of patients with tumor of the only kidney.

Efficacy and safety issues of sorafenib (Nexavar) use in the treatment of patients with inoperable locally advanced and disseminated renal cell cancer are addressed. Several clinical studies of efficacy of treatment with sorafenib both in mono-regimen and combined with other drugs are discussed.

Renal cancer is one of the most severe oncourologic diseases. In 2005, 15,733 new cases were registered in the Russian Federation. Total life expectancy of patients with advanced form of the disease is around one year unless patients respond to treatment with available late stage therapeutic agents. Therefore, delaying or preventing disease recurrence in patients with early-stage disease is critical. Oncophage was evaluated as an adjuvant treatment after nephrectomy in patients with high relapse risk in a randomized, multicenter, international Phase III study. At the moment Oncophage can be regarded as effective treatment in the adjuvant setting in the management of renal cancer patients with intermediate prognosis after radical nephrectomy.

Authors show that three-dimensional visualization significantly simplifies the differential diagnosis of suprarenal tumors and allows carrying out comprehensive planning of laparoscopic adrenalectomy even in patients with huge suprarenal tumors.

Purpose: to define diagnostic possibilities of Magnetic Resonance Imaging (MRI) with body coil in the determining of the stage and local extent of prostate cancer.

Materials and methods: Analysis of MRI studies of 49 patients aged from 48 to 78 (65±6) with confirmed diagnosis of prostate cancer who underwent radical retropubic prostatectomy in 2007 was carried out.

Conclusions: sensitivity of MRI in terms of primary diagnosis was 84% and in detection of prostate gland capsule invasion — 62%, specificity was 92%. Sensitivity of the method in terms of determining the invasion of seminal vesicles was 75% and specificity — 97%. At last, sensitivity of the method in the diagnosis of regional lymph node involvement was 40% and specificity — 98%.

Conclusion: application of MRI with surface coil allows defining the local extent of the tumor, its size and invasion of prostate gland capsule.

Purpose. The aim of our study was to define optimal time and technique of repeat transrectal prostate biopsy in patients with high grade prostatic intraepithelial neoplasia.

Materials and Methods. A total of 277 men with high grade prostatic intraepithelial neoplasia regardless of changes in serum prostate specific antigen (PSA) or digital rectal examination findings underwent follow up biopsy in 8 months (range 1—12 months) after diagnosis. All men had at least 12 (12—18) biopsy cores taken at the time of diagnosis.

Results. Prostate cancer was found in 29,2% cases (81 of 277 patiens) after the second biopsy and in 2,9 % (1 of 35) cases after the third biopsy. The highest detection rate was found using 14 and 16 core biopsy schemes 12 and 6 months after the first biopsy.

Conclusions. Our findings support the concept that high grade prostatic intraepithelial neoplasia is a precursor to prostate cancer and that repeat biopsy at a delayed interval is recommended regardless of changes in PSA.

Introduction. New facilities in the diagnosis of prostate cancer and their wide introduction into the every-day practice bring about significant changes in the epidemiology of this clinical entity.

The application of screening tests with biopsy has led to developing of heterogeneous diagnostic contingents. They are characterized by various methods of forming, by stage of disease revealed on the first level of medical aid, by demographic indices.

Objective. To evaluate the structure of the diagnostic contingents formed in the patient care institutions of Sverdlovsk region we analyzed the findings of the prostate biopsies performed.

Subjects and methods. The results of 3133 prostate biopsies carried out in five patient care institutions of Yekaterinburg for a period from 2000 to 2006 were analyzed taking into account the specificity of these institutions. All the biopsies were carried out transrectally, under the control of ultrasound.

Results. Significant differences in grouping according to the stages of newly determined cases of the disease were obtained depending on the profile of the patient care institution.

Conclusion. When evaluating the diagnosis of the prostate cancer it is necessary to take into consideration the heterogeneity of the diagnostic contingents depending on the profile of the patient care institution. The percentage of the positive biopsies findings and grouping according to the stages of newly determined cases, on the whole, may serve as epidemiologic indices.

Purpose of our study is to carry out: comparative analysis of results of radical prostatectomy and conformal radiotherapy in patients with clinically localized prostate cancer.

Materials and methods. For retrospective analysis we chose data from 177 patients with stage сT1—2N0M0 prostate cancer treated in the N.N. Blokhin Russian Cancer Research Center of Russian Academy of Medical Sciences from 1997 to 2007. Median age of patients was 61,3 years and ranged from 38 to 76 years. Before treatment median level of serum prostate specific antigen was 15,5±15,1 ng/ml and median Gleason index — 2,6±0,7 + 3,2±0,6 = 5,7±1,1. Retropubic radical prostatectomy was performed in 133 (75,4%) patients and external conformal radiotherapy — in 44 (24,6%) patients. Study groups were matched according to main parameters. Median follow-up time was 26,2±30,2 months.

Results. Prostate gland capsule invasion was found in у 43 (32,3%), perineural growth — in 56 (31,3%), invasion of seminal vesicles — in 12 (6,8%), angiolymphatic invasion — in 53 (29,9%), positive surgical margins — in 9 (5,1%), pN+ — in 7 (4,0%) from 133 operated patients. In all 44 cases compete responses to radiotherapy were registered. Among 177 patients 5-year survival was 95,0%, specific survival — 100%, and survival without PSA relapse — 76,8%. According to monofactorial and multifactorial analyses favorable prognostic factors for survival without PSA relapse are radical prostatectomy (р=0,003 and р=0,019 respectively) and Gleason index <7 (p=0,012 and p=0,045 respectively). Advantage of operated patients over the patients treated with radiotherapy in regard to survival without PSA relapse rates is statistically significant in cases with Gleason indices <7 (р=0,013) and initial level of serum prostate specific antigen <10 ng/ml (р=0,005).

Conclusion. Both surgical treatment and radiotherapy allows reaching favorable results in patients with stage cT1—2N0M0 prostate cancer. It is obvious that when choosing the preferred treatment modality the Gleason index and level of prostate specific antigen should be taken into account. Probably, repeat analysis after longer follow up time will allow drawing more definite conclusions about advantages of surgery and radiotherapy in the treatment of patients with stage cT1—2N0M0 prostate cancer of different prognostic groups.

Hormonal therapy of prostate cancer is the method of choice in patients who can not be treated radically. For patients with locally advanced renal cancer the monotherapy with bicalutamide can be used as an alternative to castration.

In our study we tried to determine the degree of decrease of prostate gland volume and level of prostate specific antigen in the serum after therapy with 150 mg of bicalutamide per day. Besides, we also attempted to clarify whether preoperative or pre-radiation hormonal therapy with bicalutamide in the dose of 150 mg per day increases the time interval to clinical progression.

After hormonal therapy we observed considerable decrease of level of prostate specific antigen in the serum. Mean volume of prostate gland also has significantly diminished in comparison to pretreatment state.

The results of our study have demonstrated that therapy with bicalutamide can be an alternative approach to maximal androgenic blockage. As well, it can be used in neoadjuvant setting as hormonal therapy before radical treatment in patients with localized and locally advanced prostate cancer.

One of the options in the treatment of hormone-refractory prostate cancer is the administration of cytostatic agents. This article addresses the Taxoter — one of the cytostatic agents. Clinical studies discussed in the article have demonstrated the high activity and efficacy of the agent which allows using it in the treatment of hormone-refractory prostate cancer.

Efficacy and safety issues of triptorelin (Diphereline) use in the treatment of patients with prostate cancer are addressed. Several clinical studies of efficacy of treatment with triptoreline both in mono-regimen and combined with other drugs are discussed.

Bladder cancer relapses are associated with diffuse pattern of neoplastic changes in the mucous layer of the bladder; treatment efficacy depends on the degree of structural alterations in the bladder wall.

Materials and methods: for evaluation of microcirculation characteristics and structural alterations of mucous layer of the bladder we have used laser analyzer of capillary blood circulation («ЛАКК-01» produced by НПП «ЛАЗМА», Russia) and compact mobile optic tomograph (ИПФ РАН, Russia).

Results: conducted researches have shown alterations affecting both epithelial and submucous layers with their microcirculatory bed in perifocal to bladder tumor tissues.

Conclusions: complimentary application of laser Doppler flowmeter and compact mobile optic tomograph allows defining the type and extent of pathologic process in the bladder wall in superficial tumors and choosing optimal method of correction.

Patients with primary diagnosis of bladder cancer (42 persons) were studied. FISH analysis performed in all patients showed the following results: 39 (93%) patients were FISH positive and 3 (7%) were FISH negative. The molecular cytogenetic criterion for determining the grade of differentiation of Ta and T1 tumors — chromosomal hyperploidy in morphologically abnormal cells, was suggested. All patients demonstrating increased amount (more than 26%) of abnormal cell with hyperploidy of chromosomes 3, 7 and 17 were found to have high grade malignancies.

Purpose: The benefit of pelvic lymph node dissection in patients with bladder cancer remains controversial. We have compared these methods of dissection in regard to the following parameters: number of extracted lymph nodes, frequency and location of identifiable metastases, complications rate, and time before development of relapses. Also we have estimated influence of clinical and intra-operative regional changes on a choice of a extent of lymph node dissection.

Materials and methods: Analysis included data on 59 patients who underwent radical cystectomy for bladder cancer between 2002 and 2008. Extended lymph node dissection was carried out in 18 patients (30,5%), and limited lymph node dissection — in 41 (69,5 %) patients.

Results: The average quantity of removed lymph nodes was 11,2 in cases of limited and 20,8 — in cases of extended lymph node dissection. Consequently, the number of revealed metastases has increased from 21,9 to 33,3%. Complex estimation of preoperative and intraoperative data has demonstrated the greatest efficiency in diagnostics of changes in lymph nodes. Among perioperative complications only frequency of lymphorrhea has appeared to be higher in patients after extended lymph node dissection. Disease-free survival rate was 9,8 months (9,4 in cases of limited and 10,1 — in cases of extended dissection).

Conclusions: Extended pelvic lymph node dissection should be recommended as a component of radical cystectomy with diagnostic and, probably, with the therapeutic purpose, especially in patients with suspicion for lymph nodes involvement arisen pre- and/or intra-operatively. Both clinical examination and intra-operative and qualitative pathomorphologic evaluation of regional lymph nodes are very important for full value staging of bladder cancer.

Introduction: Recent years with perfection of surgical techniques, anesthesia and postoperative supervision, early postoperative mortality after radical cystectomy has considerably decreased. But risk factors of mortality were not studied sufficiently.

Materials and methods: Postoperative mortality cases defined as a death within 30 days after surgery are analyzed. For determining the causes of lethal outcomes we referred to the medical documentation of the given patients, estimated the risk factors of planned radical cystectomy and preparation to it, evaluated the techniques of cystectomy and types of anesthesia, analyzed the management of risk factors after radical cystectomy.

Results: Among 100 patients treated from 2002 to 2007 postoperative mortality was registered in 4 cases, of those 3 were male patients and 1 — female. Median age of patients who underwent cystectomy was 57 years (range 38—76). The median time from cystectomy to death was 24 days (range from 9 to 30). Lethal outcomes resulted from infectious factor, were the consequences of inter-intestinal anastomosis leak-age in 2 from 3 cases, necrosis of anterior abdominal wall in 1 patient. Presence of obesity, hydronephrosis and chronic renal insufficiency (high serum creatinine) in combination with anemia significantly increases the risk of development of interintestinal anastomosis leakage.

Fatal pulmonary embolism confirmed on autopsy is noted in 1 of postoperative death cases. The patient suffered from obesity with a body mass index of 30 and had varicose vein disease of the lower extremities al illness of the lower limbs. Besides, he was a heavy smoker (35 cigarettes per day). Lethal outcome from thromboembolism of pulmonary artery occurred on 9 day after cystectomy.

Conclusions: Retrospective character of the given review allows drawing conclusions concerning contributing factors to mortality rate. Selection of candidates for cystectomy, detailed studying of the anamnesis and concomitant pathology in combination with improving anesthesia and surgical techniques as well as the careful control of the postoperative period management with maintenance of necessary standard approaches considerably reduces the development rate of dangerous complications which results in a reduction of mortality rate.

Citochem is an effective and safe medication: main active substrate of the agent is gemcitabine. Citochem in combination with cisplatin provides satisfactory efficacy without high toxicity of treatment in patients with advanced transitional cell bladder cancer and can be recommended for use in clinical practice of oncourology.