Urothelial carcinoma is the 4 th most prevalent malignant tumor after prostate (or breast), lung and colorectal cancers. Urothelial carcinoma of the upper urinary tract is quite rare and accounts for 5-10 % of all cases of this type of cancer. Tumors of the renal pelvis are 2 times more common than tumors of the ureter. A clinical case of a 69-year-old patient diagnosed with urothelial carcinoma of the left renal pelvis T2N0M1, stage IV and metastases into the bladder, right renal pelvis is presented. On 08.06.2023, the patient underwent transurethral resection of the bladder tumor, ureteric orifice, nephroureterectomy on the left, retroperitoneal lymphadenectomy. Between 07.2023 and 10.2023, the patient received 6 cycles of chemotherapy according to the following scheme: gemcitabine 1000 mg/m2 intravenously on the 1 st and 8 th days + + carboplatin AUC 5 intravenously on the 1 st day. Since 11.2023, the patient in receiving maintenance therapy with avelumab.

Introduction. Modern radiological treatment options for patients with localized prostate cancer (PCa) have several advantages and allow achieving high rates of biochemical control.Purpose of the study. To compare immediate, proximate, and long-term results of low-dose Iodine-125 brachytherapy (I-125 BT) and robotic stereotactic radiotherapy (SBRT) in patients with localized low- and intermediate-risk PCa.Materials and methods. The study included 296 patients with localized low- and intermediate-risk PCa. I-125 BT and SBRT were performed in 208 and 88 patients, respectively. All patients with an intermediate-risk PCa were prescribed neoadjuvant androgen-deprivation therapy (NADT) with luteinizing hormone-releasing hormone analogues (LHRH) for 4-6 months. Only radiation treatment was used for low-risk PCa. As a result, two groups and four subgroups of patients were formed depending on the treatment method. The immediate, proximate, and long-term results of radiation treatment methods were studied in groups and subgroups.Results. No complications were recorded during brachytherapy I-125. Radiation cystitis grade 1 and radiation rectitis grade 1 were diagnosed after SBRT in 16.6% and 4.0% of cases, respectively. In the only I-125 BT subgroup, the PSA level during the year decreased from 8.3 to 1.1 ng/ml, in the SBRT subgroup — from 7.5 to 0.8 ng/ml. In the case of combined treatment, PSA decreased from 1.2 to 0.93 ng/ml and from 4.5 to 0.5 ng/ml, respectively. Changes in prostate volume, residual volume, and urinary quality (I-PSS) were comparable in all subgroups. Five-year cancer-specific survival and overall survival in the group of patients after SBRT was 100%, after I-125 BT — more than 90%.Conclusion. Radiation treatment options for patients with localized PCa are safe. Conducting NADT does not significantly reduce the prostate volume and does not affect the indicators of urodynamics. High rates of cancer-specific five-year survival rate testify to the effectiveness of the evaluated treatment options.

Purpose: to compare immediate, short-term and long-term treatment outcomes after radical prostatectomy and robotic radiosurgery in patients with localized prostate cancer. Material and methods. The study included 2 groups of patients. Group I patients (n=80) underwent radical surgery (nerve-sparing prostatectomy). Group II patients (n=102) underwent KiberKnife stereotactic robotic radiotherapy. Results. Immediate treatment outcomes after both radical prostatectomy and robotic radiosurgery did not demonstrate increased number of postoperative complications and severe radiation-induced injuries. The PSA level decreased and reached a nadir PSA level immediately after radical prostatectomy. After stereotactic radiation therapy, the PSA level decreased gradually every three months, reaching a nadir within a year. In the group of patients receiving CyberKnife treatment, changes in the prostate volume affected the quality of urination, which was confirmed by the assessment of the volume of residual urine. When comparing the quality of urination in treatment groups using the IPSS scale, the values were comparable. No differences in the 1-year disease-free survival rates between groups were found. However, 60 months later, disease free survival rate was higher by 8.2 % in patients treated with radiosurgery than in patients who underwent radical prostatectomy (p<0.005). No differences in the 1-year cancer-specific survival rates between the groups were found. In patients, who underwent radiosurgery, the 5-year cancer-specific survival rate was 96.3 % (3.7 % higher than that observed in patients, who underwent radical surgery, p<0.005).Conclusion. High 5-year survival rates in patients with localized prostate cancer indicate that both radical prostatectomy and KiberKnife stereotactic robotic radiosurgery are safe and effective treatment options.

Москва, 7 июля 2020 г.7 июля 2020 г. состоялось заседание консультационного совета, посвященное новому комбинированному иммунохимиотерапевтическому подходу в 1-й линии терапии пациентов с местнораспространенным или метастатическим уротелиальным раком.

In the last 20 years, a concept of using multimodal programs of early rehabilitation of patients after surgical interventions – Enhanced Recovery After Surgery (ERAS) – has been developed in medicine. In oncological urology, the ERAS protocol is used only in treatment of bladder cancer. At the same time, not all available elements of this program are used despite the fact that in Russia 24.4 % of malignant tumors are urogenital tumors, and bladder cancer comprises one sixth (4.6 %) of them. Frequently, reconstructive plastic surgery is an integral part of bladder cancer treatment, and it’s accompanied by various complications many of which are associated with incorrect tactics of perioperative patient care. This situation can be dramatically improved by a more widespread use of the ERAS protocol. The immediate problem of oncological urology is development of an effective, safe, and available for wide use algorithm of postoperative rehabilitation of patients with malignant tumors of the bladder after cystectomy with cystoplasty.

Objectives. Analyzed short-and long-term results of radiation therapies (brachytherapy 125I, conformal radiation therapy, stereotactic robotic radiotherapy) of patients with prostate cancer.Materials and methods. In each treatment the patients were divided into 2 groups received the combined treatment in combination with neoadjuvant hormone therapy without its implementation. The immediate results of treatment were assessed according to the level of total prostatic specific antigen, prostate volume, residual urine, change according to the International Prostatic Symptom Score (IPSS).Results. The dynamics of these indicators comparable in both groups, which is reflected in the regression of the primary tumor, as well as the quality of life of patients. Five-year overall survival and oncospecific survival in the group of patients after stereotactic radiotherapy is 100 %, the remaining groups – of more than 90–95 %.Conclusion. The obtained results testify to the effectiveness of the proposed methods of treatment of patients with localized prostate cancer.

The article presents results of treatment of patients with localized renal cell carcinoma using the original technique of open partial nephrectomy. This technique involves the use of intraoperative ultrasonoscopy to define and mark the boundaries of the tumor and the method of creating a zone of local ischemia to resection the tumor without the use of total renal ischemia. The developed methodology in the comparative analysis of the immediate and remote results significantly (p > 0.05) reduces the amount of intraoperative blood loss without increasing the duration of the operation, reduces the risk of development of acute disorders of renal function in the early postoperative period, without compromising kidney function in the late postoperative period. This technique is comparable to the classical open radical resection of the kidney, does not affect the overall, oncospecific and relapse-free survival.

Introduction. Surgery remains the main method of treatment of patients with bladder cancer, and the only radical surgery is cystectomy with lymphadenectomy and a rationally selected method of urinary diversion. In the Chelyabinsk Regional Clinical Oncological Dispensary, an original method of orthotopic neobladder reconstruction in bladder cancer patients was developed.Objective: to improve the results of surgical treatment and the quality of life of patients with bladder cancer who underwent cystectomy.Materials and methods. The article presents results of a study of patients with bladder cancer who underwent orthotopic ileocystoplasty after radical cystectomy using a unique original technique. The reservoir was formed using a segment of the ileum of 45–50 cm in length with a 20–25 cm offset from the ileocecal junction. It’s important to preserve nutrition of the resected fragment. One of the branches of the ileocolic artery supplies blood to the distant part of the ileum which explains the necessity of the offset. After examination of the mesentery for unusual blood supply, the necessary intestinal segment was resected. Intestinal patency was restored by application of an anastomosis side-to-side with double row suture on the mucosa and serous-muscular layer. The reservoir was formed by application of an enteroenterostomy side-to-side with one row inverting continuous suture. Before that, the resected small-intestinal segment was detubulized (dissected) through the antimesenteric margin for 12–15 cm.Results. This method has the lowest rate of complications; doesn»t affect overall, cancer-specific and recurrence-free survival.Conclusion. The proposed method of neobladder formation allows to significantly improve the results of bladder cancer treatment.

The purpose of our research is to improve the quality of life of patients undergoing radical prostatectomy. With the increasing frequency of prostate cancer and determining the effectiveness of surgical treatment significantly increased the number of radical prostatectomy. Surgical treatment is definitely in much greater extent when compared to radiation treatments related to the development of impotence, erectile dysfunction and urinary incontinence.The incidence of erectile dysfunction after prostatectomy ranges from 10 to 50%. Therefore, the development of new programmes for the rehabilitation of patients can improve their quality of life, due to the greater likelihood of recovery of erectile function after the operation. In our study we observed 84 patient. The incidence of erectile dysfunction was 76%. After applying one of the existing methods of stimulation: FDÈ5 inhibitors, intracavernose injections of prostaglandin, physical therapy, we were able to increase the effectiveness of treatment up to 54.8%, 40% and 70% respectively.

There were presented results prostate cancer screening 1020 males between the ages 40 to 75 using test system ACON PSA for semi quantitative PSA analysis. 20 (1,96%) patients were under prostate cancer suspicion. Among them 4 had localized prostate cancer. The economic analysis demonstrated high efficacy and decrease expenses compared PSA screening.

The purpose of our research is to improve the quality of life of patients undergoing radical prostatectomy. With the increasing frequency of prostate cancer and determining the effectiveness of surgical treatment significantly increased the number of radical prostatectomy. Surgical treatment is definitely in much greater extent when compared to radiation treatments related to the development of impotence, erectile dysfunction and urinary incontinence.The incidence of erectile dysfunction after prostatectomy ranges from 10 to 50%. Therefore, the development of new programmes for the rehabilitation of patients can improve their quality of life, due to the greater likelihood of recovery of erectile function after the operation. In our study we observed 84 patient. The incidence of erectile dysfunction was 76%. After applying one of the existing methods of stimulation: FDE5 inhibitors, intracavernose injections of prostaglandin, physical therapy, we were able to increase the effectiveness of treatment up to 54.8%, 40% and 70% respectively.

The authors Analyzed the immediate and remote results of treatment of patients with prostate cancer treated by the method - a robotic radiotherapy. Immediate results of treatment were estimated on the level of total PSA, prostate volume, residual urine, change according to the international scale IPSS. The dynamics of the above indicators showed regression of the primary lesion, and the absence of pronounced radiation reactions affect the quality of life of patients. We analyzed the results of overall, relapse-free survival and oncospecific. Three-year disease-free survival in patients receiving radiation therapy is of 88.8%. Overall survival, as well as oncospecific survival rate is 100%.Also presents first experience of using stereotactic radiotherapy in patients of renal cell carcinoma. Treatment received two (one patient carried out the irradiation of both kidneys). In one patient, complete tumor resorption of the right kidney and a decrease in the size and reduction of contrast enhancement of the tumor of the left kidney. Renal function did not deteriorate. The second patient decreased the size of the tumor, but preserved the contrast enhancement in the vascular phase. The only function of the kidney has not deteriorated.

Background. The design and introduction of novel medicaments into clinical practice has confirmed that it is necessary to search for new prognostic factors to re-evaluate the clinical and biological properties of a tumor and to identify a subgroup of patients who will benefit from drug treatment. An individual approach and personalization of performed therapy will be able to substantially enhance its efficiency. Subjects and methods. Thirty-four oncology and urology research and health care institutions from 8 federal districts of the Russian Federa-tion took part in the investigation. It enrolled 145 metastatic renal-cell cancer patients who had received targeted therapy with a combination of bevacizumab and interferon- α (IFN- α ), in whom an objective response (complete or partial regression) or stabilization of tumor foci was recorded during at least 3-month treatment. The main task of the investigation was to estimate the clinical importance of chosen criteria (an interval from the diagnosis to start of treatment; physical activity according to the Karnofsky scale; a history of nephrectomy; the site and number of metastatic foci; the levels of hemoglobin, neutrophils, platelets, calcium, and alkaline phosphatase) as predictors for the efficiency of bevacizumab therapy. and of treatment in terms an influencing progression-free survival the levels of hemoglobin and neutrophils, age, and time to diagnosis to start therapy.