Background. Prostate multiparametric magnetic resonance imaging is widely recommended prior to biopsy in clinical practice, with the Prostate Imaging Reporting and Data System (PI-RADS) as the standard tool for guiding diagnosis and treatment decisions. However, analyzing multiparametric magnetic resonance imaging data demands substantial expertise, and the process is often time-intensive and cognitively challenging, leading to variability between and within readers.

Aim. To create a deep learning-based computer-aided diagnosis (DL-CAD) system to minimize manual influence on PI-RADS score determination.

Materials and methods. Between January 2020 and May 2024, 108 patients with histopathologically confirmed prostate cancer with PI-RADS scores 4–5 were retrospectively selected for model development and training. Additionally, 28 benign cases were included for model validation. Different prostate zones were labeled following PI-RADS v2.1 guidelines to facilitate model selection. Manual segmentation of prostate regions and lesions was performed on T2-weighted (T2W) sequences, and a 3D U-Net architecture was implemented for the DL model using the MONAI framework. Diagnostic performance was assessed using Python-based statistical analysis.

Results. The DL-CAD system achieved average accuracy of 78 %, sensitivity of 60 %, and specificity of 84 % for lesion detection. The Dice similarity coefficient for prostate segmentation was 0.71, and the AUROC was 81.16 %.

Conclusion. The DL-CAD system demonstrates promise for patients with clinically significant prostate cancer by improving diagnostic accuracy. While it exhibits high specificity, further improvements of sensitivity and segmentation accuracy are necessary. These improvements could be achieved through the use of larger datasets and advanced deep learning techniques, such as transfer learning or ensemble learning, which could enhance sensitivity without compromising specificity. Further multicenter validation is required to accelerate the integration of this system into clinical practice.

Background. Multiparametric magnetic resonance imaging and Prostate Imaging Reporting and Data System (PI-RADS) are widely used to diagnose clinically significant prostate cancer. Meanwhile, PI-RADS diagnostic accuracy varies between 30 % for PI-RADS score 3 to 80 % for PI-RADS score 5. The value of PI-RADS scores in patients already diagnosed with prostate cancer remains unclear.

Aim. To evaluate the impact of PI-RADS score on adverse surgical outcomes: prostate cancer upstaging, increased Gleason score, lymph node metastases, positive surgical margin, and oncological outcomes in patients of the ISUP grade 1 group per the International Society of Urological Pathology (ISUP) scale who underwent radical prostatectomy.

Materials and methods. Forty patients with ISUP grade 1 prostate cancer underwent radical prostatectomy (robotic or laparoscopic). All patients underwent diagnostic multiparametric magnetic resonance imaging with PI-PADS score v2 (v2.1) prior to radical prostatectomy. PI-RADS 3 was determined in 14 (35 %), PI-RADS 4 – in 10 (25 %) and PI-RADS 5 – in 16 (40 %) patients, respectively. The age of patients was 62.7 ± 6.6 years. Stage cT2a was diagnosed in 19 (47.5 %), cT2b – in 5 (12.5 %), cT2c – in 11 (27.5 %), cT3a – in 5 (12.5 %) patients, respectively. Pelvic lymph node dissection was performed in 23 (57.5 %) cases. The median follow-up was 12.6 months.

Results. Upstaging events to pT3a occurred in 2 (15.2 %) patients with PI-RADS 3 lesions, in 5 (31.3 %) patients with PI-RADS 5 lesions; upstaging events to pT3b occurred in 1 (10 %) patient with PI-RADS 4 lesions, and in 1 (6.25 %) patient with PI-RADS 5 lesions. Increased Gleason score (GS) was observed in 22 (55 %) patients: GS increase ≥2 was diagnosed in 8 (57.1 %) patients with PI-RADS 3 lesions, in 3 (30 %) patients with PI-RADS 4 lesions, in 11 (68.7 %) patients with PI-RADS 5 lesions, respectively. Lymph node metastases were observed only in 1 (4.3 %) patient with PI-RADS 5 lesions. Positive surgical margin (>3 mm) was observed in 2 (12.4 %) patients with PI-RADS 5 lesions. Biochemical recurrence occurred in 1 (2.5 %) patient with PI-RADS 3 lesions. One-year biochemical recurrence-free survival was 97.5 %.

Conclusion. Increased PI-RADS score from 3 to 5 is accompanied by increased frequency of prostate cancer upstaging and Gleason score increase in patients with ISUP grade 1 prostate cancer. PI-RADS scores 3–5 can be important in selecting patients for nerve-sparing prostatectomy, pelvic lymph node dissection, and play a part in prediction of biochemical recurrence and lymph node metastasis.

Aim. To assess the impact of topographic anatomy of the critical structures of the penile vessels on the implementation of vessel-sparing radiation therapy for prostate cancer.

Materials and methods. The study included 70 patients with verified prostate cancer. All patients underwent topometric computed tomography and magnetic resonance imaging. The target (prostate gland and proximal third of the seminal vesicles), standard critical structures (rectum, bladder, femoral heads), as well as critical vascular structures responsible for erectile function were delineated (bulb of the penis, crura of the corpus cavernosum, internal pudendal artery). The obtained images were subjected to volumetric and spatial analysis using the Eclipse 4.0 (Varian Medical System) planning system.

Results. In all 70 patients, adequate visualization of all anatomical structures was achieved. The mean distance between the apex and the penile bulb was 1.35 ± 0.47 (0.35–2.41) cm. In the majority of patients, this index exceeded 1 cm: up to 1 cm – 18 (25.7 %), between 1.1 and 1.5 – 27 (38.6 %), and more than 1.51 cm – 25 (35.7 %). The apical-cavernous distance on the right and left did not differ significantly: 2.05 ± 0.45 (1.12–3.00) and 2.09 ± 0.44 (1.16–3.02) cm, respectively. The internal pudendal artery in the projection of the irradiated volume (prostate gland and proximal third of seminal vesicles) is located at an average distance of 2.5 cm (apex gland) to 4.3 cm (basal parts of the prostate). Analysis (Spearman’s correlation coefficient) did not reveal a significant relationship between the assessed spatial parameters and prostate volume and body mass index.

Conclusion. The topographic relationship between the irradiated volumes and erectile vascular structures makes it possible to implement vessel-sparing radiation therapy protocol in the majority of cases (about 75 %).

Background. Since recently, hereditary and somatic defects in DNA homologous recombination repair (HHR) genes have been considered as promising prognostic and predictive markers for prostate cancer. However, despite the growing evidence of their prognostic significance, these biomarkers are not included in the standard prognostic classifications for primary hormone-sensitive metastatic prostate cancer (mPCa).

Aim. To assess the frequency of germline HHR DNA mutations in the Belarusian population of patients with primary mPCa and to evaluate the prognostic significance of this biomarker for long-term mPCa treatment outcomes.

Materials and methods. The study included 97 patients with primary mPCa, aged between 45 and 88 years (median age 66 years) who had their HHR DNA mutation status determined from venous blood samples. Next-generation sequencing was used for genetic analysis. All patients received standard initial treatment including androgen deprivation and docetaxel chemotherapy. Cox univariate and multivariate regression analyses were conducted for major prognostic factors and genetic status and overall survival (OS) as the endpoint. The total cohort was split into three prognostic groups.

Results. Рathogenic germline HHR DNA mutations were found in 16 patients (16.5 %; 95 % CI 9–24 %). The median OS and progression-free survival in the overall group were 31 months (95 % CI 25–38 months) and 15 months (95% CI 10–19 months), respectively. In the multivariate analysis with stepwise exclusion, the final model included two independent prognostic factors: HHR DNA mutation status (p = 0.028) and alkaline phosphatase (ALP) level (p <0.001). Based on pre-treatment ALP levels and HHR DNA mutation status, patients were categorized into groups with favorable, intermediate, and unfavorable prognosis, with median OS of 46 months, 31 months, and 18 months, respectively (p <0.0001).

Conclusion. In patients with primary mPCa, the frequency of germline HHR DNA mutations was 16.5 %. In the multivariate analysis, HHR DNA mutations statistically significantly correlated with OS. We developed prognostic classification of primary mPCa based on pre-treatment ALP levels and HHR DNA mutation status.

Background. The main method of treatment of metastatic hormone-sensitive prostate cancer (mHSPC) is drug therapy (hormone therapy, chemotherapy). However, a special category of patients with oligometastatic lesions can be identified in which addition of local treatment of metachronous metastases can be considered.

Aim. To improve the results of treatment of patients with mHSPC.

Materials and methods. The prospective single-center cohort study included patients with metachronous mHSPC oligometastases (≤5) in the bones and nonregional lymph who were treated at the N.N. Blokhin National Medical Research Center of Oncology. Metastasis-directed therapy consisted of stereotactic body radiation therapy with total dose of 27–35 Gy (3–5 fractions). The primary endpoint was 6-month recurrence-free survival (RFS), the secondary endpoints were median RFS and local control.

Results. Between 2017 and 2023, 38 patients were treated with median follow-up of 18 (3–79) months. Six-month RFS was 84.2 %, median RFS was 15 (3–62) months, local control was achieved in all 100 % of patients.

Conclusion. Stereotactic body radiation therapy is a promising approach to the treatment of patients with metachronous mHSPC oligometastases. However, determination of the true place and role of this method in treatment schemes for patients of this category requires further studies including randomized phase III trials.

Background. Radical cystectomy (RC) remains the primary surgical method for treating bladder cancer. Minimally invasive techniques, such as laparoscopic and robot-assisted cystectomy, are becoming increasingly popular due to their advantages, but they have limitations related to tumor features and patients’ clinical characteristics. To confirm the benefits of minimally invasive RC and address existing limitations, more extensive and carefully controlled studies are necessary.

Aim. To evaluate 10-year oncological outcomes of RC using minimally invasive technologies based on data from a single federal hospital.

Materials and methods. This retrospective, single-center cohort study included the results of 484 RC surgeries (open and laparoscopic) performed between January 2012 and December 2021 (10 years). Due to incomplete data, 29 cases were excluded from the analysis. The primary endpoint of the study was 10-year cancer-specific survival. The secondary endpoints were 10-year overall survival and recurrence-free survival.

Results. Cystectomy using minimally invasive laparoscopic access was performed in the overwhelming majority of patients – 408 (89.7 %) cases, with an absolute growth rate of 1300 % (p <0.001) over a 10-year period. For all patients, 10-year overall survival was 51.1 %, cancer-specific survival was 62.9 %, and recurrence-free survival was 44.1 %. Subgroup analysis based on the type of surgical approach showed a general trend towards reduced risk of death or disease recurrence favoring minimally invasive laparoscopic RC; however, no statistically significant differences were found in 10-year overall survival (hazard ratio (HR) 0.68; 0.39–1.21; p = 0.191), cancer-specific survival (HR 0.55; 0.28–1.08; p = 0.080), and recurrence-free survival (HR 0.87; 0.5–1.52; p = 0.620).

Conclusion. This retrospective cohort study identified two major trends in the surgical treatment of bladder cancer: a significant increase in the use of laparoscopic access by 1300 % over the past 10 years without worsening oncological outcomes, and an increased risk of mortality in patients over 75 years of age.

According to the World Health Organization data, in 2022 bladder cancer (BC) was the 9^th (614,298) most common cancer. In Russia, most patients (58.8 %) were diagnosed with non-muscle invasive BC (stage I) but the percentage of muscle invasive cancer (stages II–III) and metastatic BC (mBC) remains high: 32.1 and 8.3 % cases, respectively. Mortality in patients with BC in the first year since diagnosis remains high: 12.28 %. Decrease in BC mortality in the last 10 years in Russia by 22.84 % is probably due to development of new more effective drugs for mBC treatment which are the subject of this literature review.

Currently, the 2^nd line standards of treatment of patients with mBC changed due to appearance in the guidelines of the majority of the world oncological societies of new drugs classified as conjugated and targeted drugs. In patients with progression during platinum-based chemotherapy and/or immune checkpoint inhibitors, therapy with conjugate enfortumab vedotin (EV) is possible.

Enfortumab vedotin is the first of its class drug, a conjugate of a monoclonal antibody against the nectin-4 protein which is highly expressed by urothelial carcinoma and a cytotoxic chemotherapy drug monomethyl auristatin E (ММАЕ) affecting microtubules. EV was approved by the US Food and Drug Administration (FDA) in December of 2019 based on phase II trial EV-201 as part of the expedited review program due to high rate of objective responses in patients with inoperable locally advanced and mBC who previously received platinum-based chemotherapy and immune checkpoint inhibitors. In Russia, the drug was approved in 2023.

Median overall survival in all phase I–III EV trials were around 1 year and varied between 11.7 and 12.91 months, progression-free survival was a little below 6 months and varied between 5.5 and 5.8 months. In the UNITE trial based on routine practice data, median progression-free survival and overall survival since the start of EV therapy were a little higher than in the randomized trails: 6.8 and 14.4 months, respectively. Objective response rate in all clinical trials was above 40 %; in particular, in phase I trial EV-101 it was 43 %, in phase II trial EV-201 – 44 %, in phase III trial EV-301 – 41 %, and in UNITE – 52 %, while complete response rates were 5; 12; 6.9 and 7 %, respectively. In phase III clinical trial EV-301, EV therapy decreased the risk of death by 30 % compared to standard treatment (ST) and significantly increased overall survival from 8.94 months in the ST group to 12.91 months in the EV group. The risk of progression and death decreased by 37 % in the EV group, and median progression-free survival increased from 3.71 months in the ST group to 5.5 months in the EV group (p <0.00001). Additionally, objective response rate was more than 2-fold higher for EV compared to ST: 41.32 % versus 18.58 %. Approximately 30 % of patients in the EV group are alive at year 2 of the study compared to 20 % in the ST group. Safety profile also demonstrates similar results to the intermediate and primary analyses. The rates of treatment-associated adverse events of grade III or higher in the EV group in both intermediate and primary analyses of the EV-301 trial (51.4 and 52.4 %, respectively) were similar to the rates in the ST group (49.8 % and 50.5 %, respectively). The most common adverse events in the EV therapy group were rash, hyperglycemia, and peripheral neuropathy. At the same time, quality of life in the EV therapy group was higher compared to the standard therapy which confirms safety and effectiveness of EV in patients with urothelial carcinoma.

Prostate cancer (PCa) is the second most common cancer in the world, with a steady increase in incidence every year. Regardless of the chosen treatment method for patients with localized PCa, the development of local relapse occurs in at least 15 % of cases. The key point in monitoring patients with PCa today is dynamic monitoring of prostate-specific antigen levels. When biochemical recurrence is detected, the subsequent diagnostic algorithm strategy should be aimed at visualizing the tumor site, which can be local, in the lymph nodes, or metastatic. Multiparametric magnetic resonance imaging can serve as a method for diagnosing and monitoring relapses of PCa located locally or in the lymph nodes of the pelvis. When assessing relapses located in the pelvic area, one should remember possible rare sites of their localization, as demonstrated in our clinical case. The optimal treatment for recurrent PCa is still controversial and requires further study.

PSMA-targeted radionuclide therapy (PSMA – prostate-specific membrane antigen) based on the theranostic concept of “treat what we see and see what we treat” has proven to be a highly effective therapeutic modality for metastatic castration-resistant prostate cancer (mCRPC). We present an illustrative case of the effectiveness and prospects of this therapy in mCRPC. The patient aged 84 years underwent external beam radiation therapy (EBRT) to the prostate area, seminal vesicles, and regional lymph nodes at the stage of locally advanced prostate cancer (cT3aN1M0, stage IV). After 28 months of androgen deprivation therapy, castration-resistant stage of the disease was registered with multiple metastases in the bones and pelvic lymph nodes. In combination with ongoing androgen deprivation therapy, the following treatments were sequentially performed: metastasis-directed therapy through stereotactic radiotherapy to the bone lesions, apalutamide in combination with stereotactic radiotherapy to the bone and lymph node lesions, and 5 courses of docetaxel chemotherapy. Time to progression with these therapies did not exceed 6 months. From December 2022 to May 2023, ¹⁷⁷Lu-PSMA-617 PSMA-targeted therapy was performed (4 courses with an interval of 6–8 weeks, average therapeutic activity 7.6 GBq). Treatment was suspended due to development of complete radiologic response and the absence of metabolic substrate for continuation of therapy as well as total prostate-specific antigen decrease from 17 ng/mL (December of 2022) to 0.01 ng/mL (June of 2023). Among the adverse effects, the development of grade 1 xerostomia was noted. At the follow-up examination in March 2024, ECOG (Eastern Cooperative Oncology Group) score was 0, total prostate-specific antigen level was 0.05 ng/mL, complete radiologic response according to positron emission tomography/computed tomography with ¹⁸F-PSMA-1007 was registered, time without progression was 15 months. Therefore, PSMA-targeted radioligand therapy with ¹⁷⁷Lu-PSMA-617 was highly effective with low toxicity in an elderly patient with mCRPC refractory to standard drug therapy.

Sarcomatoid variant of urothelial carcinoma is a rare histological subtype: it is diagnosed in 0.1–0.3 % of all neoplasms of the bladder. The standard 1^st line therapy for all types of advanced urothelial carcinoma is chemotherapy which does not necessarily allow to achieve the best or complete responses, especially in the presence of sarcomatoid differentiation. High programmed cell death-ligand 1 (PD-L1) expression in this morphological subtype allows to assume better results of immunotherapy compared to chemotherapy. However, a large number of observations is necessary to confirm this hypothesis and suggest pembrolizumab immunotherapy as a standard 1st line therapy for metastatic urothelial carcinoma with sarcomatoid differentiation.

Prostate cancer is one of the frequently occurring malignant tumors in men with a steady increase in the number of primary diagnosed cases. Treatment of localized forms of prostate tumors should be prescribed taking into account the progression risk group.

The unresolved problem for low-risk prostate cancer patients is the redundancy of treatment while active surveillance demonstrates the highest probability of a favorable outcome. There is also a lack of consensus in the current scientific community on the most effective treatment for patients at intermediate and high risk of progression. These issues predetermined the purpose of the review: to identify the most optimal methods of treatment of localized prostate cancer taking into account the progression risk group.

The study explores how certain variations in the VEGF (vascular endothelial growth factor) gene may influence the recurrence of bladder cancer, shedding light on its development and prognosis. Bladder cancer, mainly urothelial carcinoma, is complex and unpredictable, posing challenges for treatment. Understanding genetic factors, like VEGF gene variations, can help tailor treatment plans for better outcomes. The study highlights various pathways involved in bladder cancer progression, including the role of VEGF beyond just blood vessel growth. While some research suggests a connection between VEGF gene variations and bladder cancer risk, results vary. Identifying thesevariations could lead to personalized treatments and targeted therapies. However, more research is needed to understand how these genetic factors specifically affect cancer recurrence. Collaborative efforts and advanced studies are essential for improving bladder cancer management and patient outcomes.

Stress urinary incontinence extremely negatively affects the quality of life of patients who underwent surgical treatment of malignant and benign tumors of the prostate. Surgical treatment of incontinence usually involves implantation of an artificial urinary sphincter or sling which can also cause complications. Reporting and classification of surgical complications after urinary incontinence treatment are important for systemization, evaluation, and comparison of different studies and techniques, and the current surgical Clavien-Dindo classification of complications does not take into account specifics of management of these patients and the role of infection. The developed classification is based on the principle of grading of complications depending on treatment used for its elimination (if it requires invasive intervention or not) and considers specifics of complications accompanied by infection.

Treatment of metastatic castration-resistant prostate cancer (mCRPC) is an important problem. At this disease stage, some of the most pronounced symptoms worsening the quality of life develop: bone metastases-associated pain and pathological fractures. As a rule, mCRPC causes death due to prostate cancer progression. One of the 2^nd line pharmaceuticals to treat mCRPC is Radium-223 dichloride [²²³Ra]. The use of Radium-223 increases overall survival, decreases the size, and in some cases, the number of metastatic lesions in the bones, decreases the intensity of pain syndrome and consequently the need for analgesics including narcotics. Radium-223 has a favorable safety profile and is tolerated well by the majority of patients. The review presents real clinical data on the use of Radium-223 in various countries including Russia and a network meta-analysis on the safety of mCRPC therapy using Radium-223 in combination with new antiandrogens.