During the study, the authors assessed changes in the blood coagulation system and made a spectral analysis of serum and prostate tissue. They revealed immunological changes suggesting occult disseminated intravascular coagulation, an evolving systemic inflammatory response and the latter caused by endothelial damage, microcirculatory disorders, lipid peroxidation, and release of inflammatory factors. The findings permit a tactic for medical prevention of complications to be elaborated.

The investigators analyzed the world literature on and the immediate and late results of 14 total small pelvic exenterations with different urinary tract reconstruction modalities. Postoperative complications occurred in 57.1 % of patients; postoperative mortality was 7.1 %. Late results were followed up in 12 patients. Overall survival at 10 to 48 months after surgery (median 26 months) was 83.3 %; relapse-free survival was 75 %. Urine derivation was made via orthotopic bladder plasty in 5 patients, Bricker operation in 6, and bilateral ureterocutaneostomy in 3. Functional results were regarded as good in all the patients after orthotopic bladder plasty. Thus, adequate urinary tract reconstruction allows one to expect the quality of life to be better without a negative impact on oncological results.

Fluorescence in situ hybridization (FISH) assay was used to detect tumor cells in the urine sediment of patients diagnosed as having urinary bladder cancer (UBC). For this, the investigators applied a fluorescence DNA probe kit (UroVysion) that could reveal the cytogenetic abnormalities characteristic for UBC, such as hyperploidy for chromosomes 3, 7, and 17 and deletion of the 9p21 locus, in the cast-off cells. Twenty-eight patients with the primary diagnosis of UBC, 12 with its suspected recurrence, 3 subjects without UBC were examined. The findings were compared with cystoscopic data after urine samples were taken. The sensitivity of the UroVysion test totaled 78.5 ± 9.7 % for all stages of primary cancer (pT1-pT4), 87.5 ± 11.6 % for its early stage (рТ1), and 100 % for UBC recurrences. Hyperploidy was a predominant type of cytogenetic abnormalities in the cast-off tumor cells. Among the abnormal cells, the types of hyperploidy (tri-, tetrasomy) were most common for chromosome 3 and less for chromosome 7. Thus, the UroVysion test is a noninvasive highly sensitive tool that may be used in clinical practice to improve the diagnosis of UBC, to detect recurrences, and to monitor the efficiency of treatment.

Objective: to reveal the benefits of adjuvant intravesical thermochemotherapy (TCT) and to evaluate its efficiency in the treatment of moderateand high-risk non-muscle invasive bladder cancer (BC).

Subjects and methods. In the period 2009 to 2010, the Urology Clinic, Federal Medical Biophysical Center, treated 21 patients with nonmuscle invasive BC, by using a Thermotron RF-8 clinical hyperthermal system. Intravesical TCT with mitomycin C 40 mg for 60–80 min was performed at 42 ± 2 °С as one session weekly for 6 weeks. Control cystoscopy was carried out every 3 months.

Results. Of the 21 patients, 19 were found to tolerate the procedure well. No complications were recorded in these patients during the sessions and throughout the course of intravesical TCT. A recurrence was histologically verified in 2 patients at 6-month follow-up. There was no evidence suggesting a recurrence in 12 (57.14 %) patients at one-year follow-up. The follow-up of the other patients is now less than 12 months.

Conclusion. The proposed method of hyperthermia may be used as an alternative to the existing one of intracavitary hyperthermia to treat high- and moderate-risk BC and in case of inefficiency of other adjuvant therapy options for non-muscle invasive BC.

The paper gives the results of percutaneous electroresection of the renal pelvic wall with a tumor in 4 patients. The operation has been made for absolute indications: 3 patients had a single kidney and the fourth patient had a single functioning left kidney (the right pelvic dystopic kidney failed to function). In all the patients, the primary symptom of the disease was macrohematuria, the examination for which revealed a renal pelvic tumor measuring 1.2 to 2.5 cm in size. There were no complications after percutaneous electroresection of the renal pelvic wall with a tumor. Intrarenal BCG therapy was performed in the postoperative period. Percutaneous electroresection is indicated for tumors of the renal pelvis and the upper third of the ureter of the single kidney.

Data on 435 patients with pT1N0M0 renal cancer (RC) and grade (G)2-4 and pT1–4N0–2M0 RC and G1–4 were retrospectively analyzed. A control group (n = 212) underwent nephrectomy only; in a study group (n = 223), 5-fluorouracil 500 mg/m2 and leucovorin 200 mg/m2 were injected at a 5-hour interval before treatment and once a week at the stages of adjuvant gamma-teletherapy (GTT) with 1.2 Gy + 1.2 Gy to the bed of RC and to the area of lymph nodes. In the study group, five-year survival rates for pT1N0M cancer and G2–4 were 76.5 ± 5.4 % with a median of 58.2 ± 4.7 months; in the control group, these were 57.1 ± 6.6 % and 47.8 ± 2.4 months, respectively (p < 0.05). In pT1–4N0–2M0 and G1–4, without affecting the frequency of distant metastases, adjuvant chemoradiotherapy increased the survival in the first 2 follow-up years by 16 % (p < 0.05).

The majority of clinical trials included a thoroughly selected population of patients predominantly with clear-cell renal cell carcinoma (RCC), without brain metastases and with a good somatic status. Due to the fact that in routine practice, the patient population is more heterogeneous (patients with non-clear cell RCC, brain metastases, and an ECOG somatic status of > 1, the questions arise of whether it is effective and expedient to use target drugs in this group of patients. The results of clinical trials of sunitinib with extended inclusion criteria and those of the Phase III randomized study of temsirolimus confirmed the clinical efficacy of both agents in the treatment of patients with a poor disease prognosis, non-clear cell RCC and elderly subjects > 65 years (Memorial Sloan-Kettering Cancer Center). Objective response rates and overall survival without progression were lower in this category of patients versus those with clear-cell RCC, which is likely to be due to the small number of such patients and to the lack of data of the current randomized controlled clinical trials.

Chemotherapy with docetaxel (Taxotere) used alone or in combination with other agents is today the standard of treatment for metastatic hormone refractory prostate cancer (HRPC). Nevertheless, there remain many unsolved problems associated with its use. A search for drugs, their combinations, and new therapy regimens for patients with HRPC is being continued to improve the results of treatment.

By evaluating abnormal metabolism, magnetic resonance spectroscopy (MRS) is a highly effective tool for diagnosing prostate cancer (PC). Our study has indicated that the level of citrate (Ci) and the ratio of the content of choline (Cho) and creatine (Cr) to that of citrate ((Cho + Cr)/Ci) are the most sensitive and specific indicators. These may be effectively used separately (to diagnose tumor involvement and to determine the degree of tumor differentiation) and as a part of the authors’ discriminant model.

The findings suggest that it is expedient to use MRS in the comprehensive diagnosis of PC.

 The authors analyzed the relative levels of telomeric repeat-binding protein factor 1 (TRF1) and matrix metalloproteinase-7 (MMR-7) mRNA expression by the cells obtained from prostate biopsy specimens of patients with benign prostate hyperplasia and cancer (PC) and healthy men without visible prostate diseases and calculated a TRF1/MMR-7 expression ratio for the above conditions. There was a statistically significant difference in the levels of TRF1 and MMP-7 expression and TRF1/MMP-7 ratio in the study groups, which may be suggestive of the high diagnostic value of these markers in determining the early-stage of PC and which enables clinicians to make a more accurate diagnosis in patients with various urologic diseases.

The paper presents the technical characteristics of radical prostatectomy (RPE) for early continence recovery in patients with prostate cancer. Restoration of the fascial structures of the small pelvis after RPE has been found to promote early urinary continence recovery. A method for total restoration of the fascial structures of the small pelvis (an operation after A. Tewari) and a procedure for performing posterior suspension of urethrocystic neoanastomosis in Denonvilliers’ fascia length deficit are considered, which show the similar results in the time of continence recovery.

Objective: to study orgasmic function (OF) in patients undergoing radical prostatectomy (RPE).

Subjects and methods. Seventy-nine patients who had undergone RPE for locally advanced prostate cancer without hormone and radiation therapies were examined. The patients’ mean age was 59.3 years. The mean EF-IIEF domain score was 24.4. OF was estimated by IIEF question 10 and the authors’ questionnaire. The Spearman rank correction coefficient and Mann-Whitney U-Wilcoxon tests were used.

Results. After RPE, there was a reduction in the mean IIEF question 10 score from 3.9 (confidence interval 3.7–4.1) to 3.3 (3–3.5) (p = 0.000). The following changes were found in orgasm intensity: no changes in 43 %, mild worsening in 42 %, severe worsening in 8 %, and enhancement in 4 %; orgasm could not be achieved in 4 % of the patients. Pain usually of low intensity was reported by 8.8 %. The poor factors for preserving OF were its low baseline level, elderly age, or severe post-RPE erectile dysfunction.

Conclusion. There were significant OF changes after RPE, which should be kept in mind while treating this category of patients.

Objective: to compare the results of continuous and intermittent hormone therapy (HT) in unselected patients with disseminated prostate cancer (PC).

Subjects and methods. The study enrolled 113 patients with verified stage cT2b–4N0–1M0–1 PC. The median age of the patients was 70 ± 7.3 years. The median pretreatment concentration of prostate-specific antigen (PSA) was 309.8 ng/ml. The cT2 category was diagnosed in 12 (10.6 %) patients, сТ3 in 85 (75.2 %), сТ4 in 16 (14.2 %), сN+ in 32 (28.3 %), and М+ in 74 (65.5 %). At baseline, the median Gleason grade was (3.0 ± 0.8) + (4.0 ± 0.9) = 7.0 ± 1.7. All the patients received immediate HT: castration therapy was performed in 2 (1.8 %) patients, maximal androgen blockade in 96 (85 %), and antiandrogen monotherapy in 15 (13.3 %). Continuous and intermittent treatment regimens were used in 100 (70.8 %) and 33 (29.2 %) cases, respectively. The median follow-up was 31.9 ± 17.7 months.

Results. The intermittent HT regimen was associated with a significant increase in overall survival versus that during continuous treatment (medians 57.8 ± 11.6 and 25.2 ± 2.8 months, respectively; p = 0.031). Overall survival benefit remained in the poor prognosis (bone pain and/or a PSA of  100 ng/ml and/or сТ4 and/or М+) group. The HT regimen failed to affect survival in the good prognosis (no bone pain, a PSA of < 100 ng/ml, сТ < T4, М0) group. Impotence was less common during intermittent treatment than during continuous ablation (68.2 and 96.2 %, respectively; p = 0.002). No relationship was found between the incidence of other complications and the HT regimen. There was no significant difference between the groups in quality-of-life indicators before and during treatment. The average cost of an intermittent course of therapy per year was significantly lower than that of a continuous course (50586.7 and 72996.0 rubles, respectively; p < 0.0001).

Conclusions. Intermittent HT fails to result in a clinically relevant worsening of the quality of life, promotes better sexual function, and is economically expedient. In the poor prognosis group, intermittent treatment causes a significant increase in the time to hormone refractoriness and in overall survival rates as compared with these indicators when the continuous regimen is used. Intermittent therapy is as good as continuous ablation for overall survival among the good prognosis patients.

Prostate cancer (PC) is one of the most common cancers. Hormone therapy (HT) is the basic treatment for metastatic hormone-sensitive PC. HT with luteinizing-hormone-releasing hormone (LHRH) analogues is considered to be an effective method for hormone exposure as monotherapy and in combination with other drugs. Lucrin depot® is a potent and safe LHRH analogue whose efficacy has been proven by a number of clinical trials. This drug may be recommended as monotherapy or in combination with other hormonal agents in patients with PC if there are indications for androgen deprivation.

The analysis of the performed study has established that zoledronic acid is an effective agent in multimodality therapy for locally advanced prostate cancer (PC) and allows long-term stabilization of bone tissue. In addition, there is evidence for the efficacy of zoledronic acid in preventing bone metastases (BM) and increasing the time to the first BM. The currently accumulated experience with zoledronic acid used in PC permits one to consider its use as standard concomitant therapy.

Degarelix (Firmagon) (Ferring Pharmaceuticals) is a new gonadotropin-releasing hormone (GnRH) antagonist permitted and approved for use in the treatment of hormone-dependent prostate cancer. It is recommended to administer the drug subcutaneously in the abdomen in a starting dose of 240 mg, followed by monthly maintenance doses of 80 mg. The Phase III randomized trial demonstrated that degarelix had advantages over the GnRH agonist leuprorelin in the reduction rates for testosterone to castration levels and for prostate-specific antigen (PSA) levels and in the absence of the initial increase and variations of androgen concentrations during treatment. A one-year follow-up showed that the risk of PSA recurrence and death with leuprorelin was significantly higher than that with degarelix. There was a significant reduction in the risk of PSA recurrence in patients switched from leuproprorelin to degarelix. The rates of adverse reactions and treatment discontinuation in the degarelix treatment group do not differ from that in the leuprorelin group. Long-term follow-up studies are required to draw final conclusions.

The paper presents a clinical observation of patient K. who has undergone single left kidney re-resection 5 years after extracorporeal resection for renal cancer recurrence. Active surgical policy as re-resection of the autografted kidney has been found to be sound and to yield satisfactory functional results.

Overall survival is about 100 % in patients with stage I testicular germ cell tumors after orchofuniculectomy, which is achieved, by applying alternative adjuvant approaches. Methods, such as a follow-up, chemotherapy or retroperitoneal lymphadenectomy, may be used to treat nonseminomatous germ cell tumors. The paper shows the main advantages and disadvantages of the above treatment options.