Background. The search for new prognostic markers of renal cell carcinoma is an urgent problem of oncourology. Modern studies demonstrate the need for a comprehensive assessment of the clinical and prognostic significance of many markers.

Aim is a comprehensive analysis of the prognostic significance of soluble forms of PD-1 and PD-L1 (sPD-1 and sPD-L1) depending on the phenotype of tumor cells and the microenvironment.

Materials and methods. The study included tumor tissue and serum samples from 54 patients with renal cell cancer and from 67 healthy donors. The concentrations of sPD-1 and sPD-L1 were determined in blood serum using ELISA. Tissue expression of PD-L1, PU.1, CD3, and CD20 was assessed by immunohistochemistry. To determine statistically significant differences in independent groups, the Mann–Whitney test and Fisher’s exact test were used. Overall survival was analyzed by constructing survival curves using the Kaplan–Meier method. Differences were considered statistically significant at p <0.05.

Results. Increase of sPD-L1 concentration in serum from patients with renal cell carcinoma compared with healthy donors was demonstrated. The highest concentration of the soluble form of the PD-1 receptor was observed in serum from patients with the non-clear cell renal cell carcinoma. High levels of sPD-L1 in serum and PD-L1 in tumor cells are associated with disease progression (advanced stage, higher malignancy, as well as the presence of regional metastases). It has been shown that the high content of PU.1+ and CD20+ cells in the tumor stroma are significant factors of unfavorable prognosis. No prognostic significance was found for both sPD-L1 and PD-L1 expressed in tumor tissue. However, analysis of a combination of these markers showed that the high concentration of sPD-L1 together with the high tissue expression of PD-L1 is an extremely unfavorable factor.

Conclusion. Analysis of sPD-L1 concentration and tissue expression of PD-L1 in combination is a new approach for assessing the prognosis of renal cell carcinoma.

Background. In the first part of our study, we described the dynamics of kidney cancer (С64) incidence and mortality, as well as reliability of kidney cancer surveillance in Russia. This study analyzed the effectiveness of cancer control measures in Russia by assessing patient survival using the data form the newly developed Population-based cancer registry of the North-Western Federal District.

Materials and methods. We used the data from the Population-based cancer registry of the North-Western Federal District of Russia that has more than 1,350,000 records, including 35,629 kidney cancer patients. Standard methods of the European Network of Cancer Registries (EUROCARE program) were used for data processing and analysis.

Results. Our findings confirmed that kidney cancer is characterized by a low death rate. Over the last 18 years, median survival of kidney cancer patients in the North-Western Federal District of Russia increased form 4 years to 6.5 years. The 1-year survival rate increased from 68 % to 78.5 % (by 16.5 %); 5-year cumulative observed survival increased from 47.3 % to 54.1 %; 5-year cumulative relative survival increased from 56.8 % to 61.8 %. Female kidney cancer patients demonstrated higher 5-year cumulative survival rates than male patients (65.8 % vs 43.9 %).

Conclusion. We observed a positive dynamic of the main analytical indicators of cancer control, including an increase in the median survival and 5-year cumulative survival of kidney cancer patients.

Background. Excessive expression of survivin is associated with inhibition of cell death, activated by extrinsic or intrinsic apoptotic pathways. The survininin overexpression has been shown in various malignancies, including lung cancer, pancreatic and breast cancer, colon cancer, oral squamous cell carcinoma and high grade non-Hodgkin lymphomas.

Aim. To investigate the level of survivin expression in prostate cancer tissues, and evaluate it as a diagnostic marker of prostate cancer.

Materials and methods. The level of survivin expression and its subcellular localization were assessed immunohistochemically in patients with prostate cancer (n = 64) and benign prostatic hyperplasia (n = 33). Tissue samples obtained at transrectal biopsy were used for analysis. Prostate cancer samples obtained after cystprostatectomy in patients with normal prostate specific antigen level and normal ultrasound findings (n = 36) were considered control tissue (norm).

Results. In prostate cancer group 3+ samples with a high level of survivin expression were present in 48.4 % of cases. In benign prostatic hyperplasia group the majority of samples were assessed as 2+, while 9.1 % of samples were negatively stained. 100 % of normal epithelium samples were negative. In patients with Gleason score <7 a survivin expression level was less than 3+ in 62.5 % of cases, and in patients with Gleason score >7 a highly positive reaction was detected in 68.8 % of cases. A high level of survivin expression was found in the large proportion of tissue samples at prostate specific antigen levels >10 ng/ml. Almost 50 % of highly positive cells were detected at a prostate health index (PHI) value of ≥60. The largest percentage of negative staining for surviving was common with PHI value <25. The degrees of staining for survining 1+ and 2+ prevailed in patients with prostate health index density (DPHI) <0.8, while a high level of prostate cells staining 3+ was observed at >0.8. As a Gleason score increase we observe the change of staining type for nucleocytoplasmic, and the largest number of samples has a staining degree of 2+ at a score GG4–5 (≥4 + 4). The type and frequency of prostate tissue samples staining were not differ depending on the initial prostate specific antigen level.

Conclusion. Immunohistochemical assessment of the survivin level, including its subcellular localization, could be considered as tumor-associated and a potential biomarker for differential diagnosis and prediction of prostate cancer course.

Background. Focal therapies for prostate cancer (PCa) can preserve the quality of life; however, their application is limited by lack of confidence in identifying the exact tumor location.

Aim. To evaluate the utility of fusion biopsy for choosing PCa patients eligible for focal therapy with subsequent confirmation by the analysis of radical prostatectomy (RPE) samples.

Materials and methods. This study included 122 patients with histologically verified stage Т1–2N0M0 PCa treated in N.A. Lopatkin Research Institute of Urology and Interventional Radiology, a branch of the National Medical Research Radiology Center. Their mean age was 65.2 ± 6.8 years. All patients underwent multiparametric magnetic resonance imaging and fusion biopsy (samples were collected from targeted areas in combination with a standard biopsy), followed by histological examination of biopsy samples and mapping of the affected areas. Twenty-eight patient underwent RPE.

Results. Study participants were distributed as follows by their Prostate Imaging Reporting and Data System (PI-RADS) score: 5 points in 23 patients (18.9 %), 4 points in 57 patients (46.7 %), and 3 points in 42 patients (34.4 %). Targeted biopsy revealed cancer in 105 out of 122 patients (86.1 %) in at least one sample. Seventeen targeted biopsy samples were negative. The majority of patients had ISUP (International Society of Urological Pathology) grade 1 (n = 57; 46.8 %) and grade 2 (n = 33; 27.0 %) tumors. Comparison of biopsy findings and results of pathological examination of the removed prostate demonstrated significant discrepancies in the distribution of cases by their ISUP grades. Almost half of the patients (46.8 %) were diagnosed with ISUP grade 1 tumors after biopsy, while the assessment of RPE specimen demonstrated ISUP grade 1 tumors only in 21.4 % of patients. ISUP grade 3 tumors were diagnosed in 16.4 % and 35.7 % of patients using biopsy- and RPE-derived specimens, respectively. The proportions of ISUP grade 2, 4, and 5 tumors were similar with both methods. In 27 out of 28 cases, examination of biopsy- and RPE-derived specimens demonstrated complete agreement in terms of tumor location. Importantly, this study included only patients with histologically confirmed PCa; so we didn’t evaluate the effectiveness of biopsy for cancer diagnosis. Focal therapy could have been considered in 22 out of 28 patients (78.6 %) who underwent RPE. This proportion of focal therapy-eligible patients is almost equal to that identified by fusion biopsy (75.4 %).

Conclusion. Multiparametric magnetic resonance imaging in combination with targeted and multifocal prostate biopsy allow precise identification of candidates eligible for focal therapy with a relatively low risk of an erroneous conclusion.

Background. Currently, in men suffering from prostate cancer, histological examination of the material obtained during pelvic lymphadenectomy (PLAE) is the most accurate and reliable method for staging the tumor process and postoperative prognosis of disease outcomes, an important factor influencing the choice of the most rational treatment tactics after radical prostatectomy. However, today questions about the therapeutic (oncological) expediency of PLAE and its safety in terms of the development of intra- and postoperative complications remain debatable.

Aim. To was to compare the perioperative and therapeutic (oncological) results of radical prostat ectomy performed in combination with standard or extended PLAE.

Materials and methods. The study materials were the data of medical records of 812 men aged 43 to 78 years, at different times (from January 2009 to December 2018) who were hospitalized for localized or locally advanced prostate cancer in stages cT1a–cT3bN0M0. The research method was a retrospective analysis of the data contained in the selected medical records.

Results and conclusion. The results of our studies, firstly, confirm the conclusions of the European Association of Urology (EAU) experts on the justification and necessity of performing an extended PLAE with radical prostatectomy in order to diagnose metastatic lesions of the pelvic lymph nodes in individuals with an intermediate or high risk of prostate cancer progression; secondly, they indicate a higher therapeutic efficacy of extended PLAE compared to that for standard PLAE, which is expressed in a statistically significantly three times lower incidence of biochemical relapses and an 11.4 % longer relapse-free period after extended PLAE than after standard PLAE. Extended PLAE, performed in one surgical session with radical prostatectomy, is not a risk factor for the development of various intra- and postoperative complications, with the exception of the lymphocele, which is formed in 3.7–13.5 % of cases of extended PLAE due to intraoperative transection of lymphatic vessels and lymph accumulation at the site of the removed adipose tissue.

Background. Bladder neck preservation during retropubic radical prostatectomy (rRP) promotes a protective effect on urinary continence compared to standard rRP.

Aim. To assessment of possible predictors for positive surgical margin (PSM) recognition is an important step.

Materials and methods. 136 patients with localized prostate cancer (PCa) were studied in the study. Group 1, 90 patients (retrospective assessment), underwent standard rRP, group 2, 46 patients (prospective assessment), underwent rRP modified by bladder neck preservation with a part of the proximal prostatic urethra. The clinical and pathological stages of PCa were assessed; the groups were compared to the parameter PSM. Statistical analysis was performed using nonparametric statistical methods.

Results. Both groups were comparable in age and baseline total prostate specific antigen (PSA) but differed in prostate volume and Gleason score. Also, there were differences in clinical and pathological stages of PCa. PSM-patients had more aggressive PCa according to the International Society of Urological Pathology (ISUP) and TNM classifications and had higher progression risk prognosis stages. In PSM-patients, correlations were determined between prostate volume and baseline Gleason index (r = 0.338; p >0.05); baseline total PSA and Gleason score before (r = 0.529; p >0.05) and after (r = 0.310; p >0.05) rRP, respectively. Nevertheless, the incidence of PSM among all subjects was 6.6 % of cases, while in groups 1 and 2 was 7.8 and 4.3 % of cases, respectively. In this way, surgical techniques that maximize bladder neck preservation with a part of proximal prostatic urethra have no significant effect on PSM. Ranges of total PSA, clinical stage of PCa, Gleason score and progression risk stages (prognostic group for PCa) were determined as predictors of PSM. Their use will make it possible to establish patient selection criteria for bladder neck preservation with proximal prostatic urethra during rRP.

Conclusion. The identified predictors will allow determining during clinical staging minimal risks of detecting PSM. The rRP modified by bladder neck preservation with part of the proximal prostatic urethra does not increase the incidence of PSM compared to the standard rRP. The feasibility of this technique should be related to total PSA, clinical stage of PCa, Gleason score, and the progression risk stage.

Background. Prostate cancer (PCa) is an actual disease and a frequent oncological pathology in men. The main methods of radical treatment of patients with PCa are radical prostatectomy and radiation therapy. Radical prostatectomy s the most commonly used method of therapy in patients with localized PCa. Adjuvant hormone therapy after surgical treatment is the standard method of therapy in patients with the presence of lymph node metastases. At the same time, the standard approach of treatment of patients with metastatic PCa is combination therapy with medical (using of analogues or antagonists of luteinizing hormone-releasing hormone (LHRH) or surgical castration in combination with chemotherapy with docetaxel or new generation antiandrogens (enzalutamide or apalutamide)). Numerous studies have demonstrated the importance of achieving minimum testosterone levels at all stages of drug therapy in patients with PCa. It has also been shown that the use of LHRH analogues may be less effective to the use of LHRH antagonists (degarelix) in relation to the effectiveness of testosterone suppression. Thus, conducting a study aimed at studying the effectiveness of testosterone suppression using LHRH antagonists in various clinical situations and patient populations in real clinical practice is a very actual task.

Aim. To evaluate the effectiveness and safety of castration therapy using degarelix in real clinical practice and in various clinical situations.

Materials and methods. The object of an observational non-interventional study was 132 patients with PCa from 13 cancer centers of Russian Federation who were treated with LHRH antagonist degarelix. The study was non-interventional (observational), retrospectively-prospective, open multicenter and not randomized. In accordance with the design of the study, depending on the clinical situation, patients were divided into 3 groups: group A (n = 52; 39.4 %) – patients with primary metastatic hormone-sensitive PCa, who were shown to undergo combined drug treatment with castration therapy as one of the components; group B (n = 43; 32.6 %) – patients, who underwent combined hormonal and radiation treatment (ADT + radiation therapy); group C (n = 37; 28 %) – patients who underwent surgical treatment (radical prostatectomy with extended PLND) with the presence of metastases in the lymph nodes identified by the results of a morphological examination (pN1).

Results and conclusion. As a result of a non-interventional observational study, high efficacy of androgen-deprivation therapy with the use of degarelix was demonstrated in relation to the suppression of testosterone and PSA in patients with primary metastatic and locally advanced PCa in various clinical situations, as well as low toxicity and satisfactory tolerability of this variant of hormonal treatment.

Aim. To study the clinical and demographic profile of patients with non-metatstatic castration-resistant prostate cancer (nmCRPC) and clinical approaches to the treatment of nmCRPC in the context of daily medical practice before and after progression M1 stage.

Materials and methods. The multicenter non-interventional epidemiological study were included 200 patients with a documented diagnosis of nmCRPC from 2019 to 2020. Each patient visited twice: start and after 6 months. Of the 200 patients included, 9 were excluded from the analysis presented in this article: 1 patient had no information on inclusi- on criteria, 1 patient did not meet the inclusion criteria, 7 patients did not attend visit 2. Thus, data are presented for 191 patients.

Results and conclusion. The median age was 74.3 years (range 55 to 91). 72 % (137/191) had a disability group. The most common comorbidities were hypertension (n = 115) and hypercholesterolemia (n = 56). The median time from the diagnosis of prostate cancer to the development of castration resistance (diagnosis of nmCRPC) was 75 months. Prostate specific antigen (PSA) nadir (0.37 ng/ml on average) was achieved after 15 months of prostate cancer therapy (median time to reach PSA nadir). At the same time, PSA doubling time in most cases (47.6 %; 91/191) was less than 6 months, 18.8 % of persons (36/191) had PSA doubling time for more than 10 months.

Background. Bladder cancer is a serious problem of modern oncourology due to the annual increase in the number of diagnosed malignant neoplasms of the urinary system. High-risk muscle-invasive and non-muscle-invasive forms are subject to surgical treatment, while open radical cystectomy serves as the “gold standard”. Laparoscopic and robot-assisted radical cystectomy are serious competitors to this method. To date, the robotic method of removing the bladder is the least studied, despite the fact that it seems to be the most technologically advanced and modern.

Aim. To analyze the own results of the use of robot-assisted interventions in high-risk musculoskeletal and non-musculoskeletal invasive bladder cancer, as well as to study the literature on the use of robot-assisted radical cystectomy in the treatment of malignant neoplasms of the bladder.

Materials and methods. A prospective study was conducted on the basis of the clinic of the Bashkir State Medical University with the participation of 70 patients who were diagnosed with bladder cancer (T1–T4). The subjects underwent a robot-assisted radical cystectomy with various variants of urine derivation.

Results. At the end of the study, the outcomes after robot-assisted radical cystectomy were analyzed and evaluated. The primary endpoints were 30- and 90-day complications of the Clavien–Dindo system. According to secondary indicators, robot-assisted radical cystectomy demonstrated a low duration of surgery, intraoperative blood loss.

Conclusion. Robot-assisted radical cystectomy is a serious competitor to open and laparoscopic interventions for early and long-term perioperative indicators. This technique has shown its profitability in the treatment of bladder cancer, demonstrating a sufficient level of effectiveness and safety.

Background. Survival rates play an important role in improving the organization of oncological care and individualization of treatment methods. The presence of databases of patients with bladder cancer in the Samara region makes it possible to study survival at the population level, taking into account the place of residence, gender, stage of the disease, the histological structure of the tumor, and allows you to participate in the further formation of the federal cancer registry as part of the digitalization of healthcare.

Aim. To study of survival rates for bladder cancer in the Samara region for the period 2010–2012 with the calculation of 5-year survival for 2017.

Materials and methods. The study included data on 1138 patients with newly diagnosed bladder cancer. Calculation and analysis of relapse-free, overall and tumor-specific survival of 1059 patients with bladder cancer was carried out, taking into account the place of residence and gender differences. Of these, 846 (79.9 %) people are urban residents, 213 (20.1 %) are from rural areas (4:1). A comparative analysis of the survival of patients with bladder cancer for 2000–2002 and 2010–2012 was performed. The Kaplan–Meier method was used to calculate survival rates.

Results. An analysis of the survival of patients with bladder cancer found lower overall survival compared to tumor-specific survival, which indicates the presence of intercurrent causes of death. In the population of the region as a whole, 1-year relapse-free, overall and tumor-specific survival in this disease was 75.9, 77.9 and 81.1 %, 5-year – 55.7, 53.8 and 66.6 %, respectively. An assessment of the dynamics of the probability of living each year showed that the majority of patients (18.9 %) die during the first year of observation, in subsequent years the probability of survival is much higher. Life expectancy in urban areas is longer than in rural areas. Comparison of gender differences in survival revealed lower survival rates in the male population. Indicators of 1-year and 5-year tumor-specific survival of patients for 2010–2012 increased by 5.7 % and 13.6 %, respectively, as compared to 2000–2002.

Conclusion. Comparative analysis of 1-year and 5-year survival of patients with bladder cancer in the Samara region for 2010–2012 determined the low survival rates of rural men compared to urban ones. Higher survival rate for this disease for 2010–2012 compared to 2000–2002 may indicate an increase in the availability of specialist care to the population and careful monitoring of patients in the last decade of the study.

The aim of this work was to clarify and extend the existing clinical guidelines on organ-sparing treatment of muscleinvasive bladder cancer. The standard protocol of radical conservative treatment for muscle-invasive bladder cancer includes transurethral resection of the bladder, external beam radiotherapy with simultaneous chemotherapy (radiosensitization), which is usually referred to as trimodal therapy. The implementation of trimodal therapy into routine practice in Russia is limited due to the lack of distinct criteria for each of the stages. The involvement of surgeons, radiation oncologists, and chemotherapists, on the one hand, provides the required multidisciplinary approach to cancer treatment; on the other hand, it might impede the entire algorithm. To address this problem, specialists from the Department of Radiology (project moderators), Department of Cancer Urology, and Department of Chemotherapy of N.N. Petrov National Medical Research Center of Oncology under the auspices of Saint Petersburg Oncological Research Society formed a group of experts, including radiation oncologists, urologists, and chemotherapists from federal and local cancer (educational) institutions of Saint Petersburg who had an experience of treating muscle-invasive bladder cancer. The guideline was developed with the consideration of available guidelines published by leading professional associations of radiotherapy and oncology (urological), research articles, and own experience.

Aim. To assess the frequency and timing of drainage associated complications in patients after palliative nephrostomy with nephrostomy tubes of various diameter and design. To establish a relationship between the presence of diabetes mellitus and the risk of acute pyelonephritis.

Materials and methods. The records of 73 patients who received care between January 2018 and May 2021 were retrospectively reviewed for complications, related to nephrostomy tube. 201 cases of patient attendance due to nephrostomy tube dis-lodgement, nephrostomy tube obstruction and pyelonephritis were analyzed. The frequency and timing of the onset of complications in groups of patients with J-type (<12 Fr) and balloon-type (≥12 Fr) drains were separately assessed.

Results. In total, there were 100 visits of patients with J-type catheters and 101 visits with balloon nephrostomy catheters. The reasons for attendance among patients with J-type nephrostomy tube were: impaired drainage function (46 %), pyelonephritis (35 %) and dislocation of the catheter (19 %); and for patients with balloon catheters: pyelonephritis (39 %), impaired drainage function (34 %), dislocation (27 %). Patients with diabetes mellitus were significantly more likely (p <0.05) to develop pyelonephritis than those who did not have diabetes.

Conclusion. The most common reasons for the urgent hospital attendance of patients with nephrostomy drainage are pyelonephritis and inadequate function. Diabetes mellitus is a risk factor for the development of pyelonephritis in this group of patients.

Background. The presence of visceral metastases (VM) is a significant adverse prognostic factor affecting the overall survival of patients with metastatic hormone-sensitive prostate cancer (mHSPC). Recently, new drugs, such as novel antiandrogen therapies (NAT), have been introduced, expanding the options for the treatment of mHSPC.

Aim. To assess whether presence or absence of VM at baseline affects risk of death in patients with mHSPC receiving NAT therapy in combination with androgen deprivation therapy (ADT) compared with standard therapy (ADT ± 1st generation antiandrogen).

Search strategy. Bibliographic databases PubMed and Google Scholar were searched from inception through January 21, 2022.

Selection criteria. Eligible studies were randomized clinical trials with parallel design in patients with mHSPC. Subgroups of patients with or without VM at baseline were required. The following drugs were chosen as interventional agents: abiraterone acetate, apalutamide, enzalutamide, darolutamide. All in addition to ADT. The main outcome was overall survival.

Data analysis. We applied the inverse variance technique for the meta-analysis of hazard ratios (HR). In HR analysis we adopted a fixed-effect model.

Results. The analysis included three randomized clinical trials with 3376 patients, of which a total of 485 (14.4 %) patients had VM. Compared with ADT, the risk of death in patients with VM treated with NAT + ADT (HR 0.69; 95 % confidence interval (CI) 0.53–0.89; n = 485; p = 0.004) was similar to the risk of death in patients without VM (HR 0.66; 95 % CI 0.59–0.75; n = 2461; p <0.00001). The test for subgroup differences suggests that there is no statistically significant subgroup effect (χ² = 0,05; df = 1; p = 0,82; I² = 0 %). Ordered from the most to the least effective, treatments with improved overall survival in patients with VM when added to ADT included abiraterone acetate (HR 0.58; 95 % CI 0.41–0.82), apalutamide (HR 0.76; 95 % CI 0.47–1.23), enzalutamide (HR 1.05; 95 % CI 0.54–2.04). In patients without VM, the drugs are in the following order: enzalutamide (HR 0.62; 95 % CI 0.47–0.82), apalutamide (HR 0.65; 95 % CI 0.52–0.81), abiraterone acetate (HR 0.69; 95 % CI 0.58–0.82).

Conclusion. Patients with mHSPC benefit from the combination of NAT with ADT, regardless of the presence or absence of VM (HR 0.67; 95 % CI 0.60–0.75; n = 2946; p <0,00001). Abiraterone acetate has the greatest advantages in reducing the risk of death in patients with VM.

Prostate cancer is one of the most common malignant diseases in men. Viral infections can be risk factors for prostate carcinogenesis. Based on the literature review, an assumption can be made about the pathogenetic role of viral infections in prostate carcinogenesis. Further study of this problem is required, the solution of which can make a great contribution to the diagnosis and prevention of prostate cancer

Recently, there has been a worldwide increase in the incidence of bladder cancer. Improved morphological diagnostics, increased surgical activity and availability of chemotherapy allowed reducing the one-year mortality rate and increasing the five-year survival rate. However, at the same time, there was a struggle with complications arising after the treatment. According to the world and domestic literature, it is noted that with an increase in life expectancy in patients who underwent radical cystectomy with intestinal urine derivation, an almost twofold increase in the frequency of complications, including the formation of urinary stones, is recorded. Previous studies have shown that about 60 % of the stones identified in this category of patients are infectious, and 40 % formed because of metabolic disorders, which have their own characteristics with different types of urine derivation. In this work, we present an overview of the predisposition for stone formation in patients who underwent cystectomy for musculoinvasive bladder cancer, taking into account the type of urine derivation.

Spontaneous tumour regression is a rare phenomenon in which there is a complete or partial regression of the primary tumour, clinically manifested by metastatic lesions. We report a case of a 34-year-old male with partial spontaneous regression of testicular seminoma detected by a supraclavicular lymph node biopsy. He underwent inguinal orchifunicolectomy. Based on the results of histological examination, against the background of multiple complexes of intratubular germ cell neoplasia in situ, foci of invasive growth and involution were identified, indicating a spontaneously regressing testicular tumour. We report the second case of a 52-year-old male with total spontaneous regression of testicular seminoma detected by a spermatic cord biopsy. Based on the results of histological examination, against fibrosis and proliferation of Leydig cells, there are atrophy of seminiferous tubules and complexes of intratubular germ cell neoplasia in situ in part of them.

Ewing’s sarcoma is a highly aggressive malignant tumor that often affects the bones. Genitourinary organs are an exceedingly rare location of the Ewing’s sarcoma. There are still no widely accepted treatment protocols for such patients. We report a rare case of Ewing’s sarcoma of the ureter in a 68-year-old man who was admitted to the Cancer Research Institute, Tomsk National Research Medical Center. He was suspected of having a bladder tumor. After completing his treatment course which included surgery and adjuvant chemotherapy, the patient demonstrated no signs of local recurrence or metastasis for a long time.

This article presents a case report of hereditary leiomyomatosis and renal cell cancer (HLRCC) with new mutation in a 25-year-old female patient admitted to the clinic for diagnosis and treatment due to multiple skin and uterus leiomyomas. The patient has a history of surgery to remove adrenal pheochromocytoma and papillary kidney cancer. Clinical and laboratory examination as well as medical genetic counseling of the patient were performed. We have detected the heterozygous c.395_399del (p.L132*) germline nonsense mutation in exon 4 of the FH gene using polymerase chain reaction/Sanger sequencing of exons 1–10 of this gene and confirmed the diagnosis of HLRCC. The mutation c.395_399del in a patient with HLRCC was described for the first time. The identical mutation was also found in the mother and sister of the patient. Based on the obtained results, medical genetic counseling was carried out in this family, recommendations were given for further oncological monitoring. The case report could be useful for geneticists, oncologists and other specialists to interpretate the clinical heterogeneity of HLRCC and improve the genetic diagnosis of this rare hereditary oncological syndrome.

Aim. To improve diagnostics and screening of prostate cancer to ensure early detection of malignant tumors.

Materials and methods. We analyzed the population size and structure in the region in 2005–2010. The primary diagnostics of prostate cancer in regional healthcare institutions allowed the detection of locally advanced tumors and generalized cancer. Such diagnostic approaches can produce only accidental diagnosis since they lack proper systematization, organization, and control.

Results. We have developed and implemented into clinical practice a long-term Program for Prostate Cancer Early Diagnosis and Screening. It includes a diagnostic algorithm for prostate cancer that was modified for clinical use. Screening starts with the PSA blood test performed annually. Patients with PSA level >10 ng/mL should undergo additional diagnostic procedures. The Program implies active use of currently available information technologies to implement a unified routing scheme for cancer patients, execute measures for early cancer diagnosis, and warrant promptness and reliability of the cancer registry.

Conclusion. Implementation of the long-term Program for Prostate Cancer Early Diagnosis and Screening will help to improve prostate cancer diagnosis, and, therefore, treatment outcomes.

This appendix formed part of the original submission and has been peer reviewed.We post it as supplied by the authors. Supplement to: Motzer R, Porta C, Alekseev B, et al. Health-related quality-of-life outcomes in patients with advanced renal cell carcinoma treated with lenvatinib plus pembrolizumab or everolimus versus sunitinib (CLEAR): a randomised, phase 3 study.

Lancet Oncol 2022; published online April 27. https://doi.org/10.1016/S1470-2045(22)00212-1.