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Background Intraoperative rectal injury in prostatectomy patients is an uncommon but severe complication. Particular attention is paid to improving the results of healing damage to the anterior rectal wall during prostatectomy.Objective To study the morphological features of the parietal pelvic fascia and the rectal wall to substantiate the possibility of the formation of fascial duplication in the elimination of damage to the anterior rectal wall during prostatectomy.Material and Methods The authors carried out an intravital morphological analysis of the parietal pelvic fascia covering the levator rectum muscle and the anterior rectal wall in 10 men.Results The parietal pelvic fascia contains more powerful bundles of collagen fibers, which in certain areas are partially woven into the fibers of striated muscle tissue. The adventitia of the rectum is characterized by a looser arrangement of the interacting components of the formed connective and smooth muscle tissue. In the studied formations of the small pelvis, the thickness of collagen fibers separately and in the composition of bundles, as well as the cells of the differon and each fiber separately did not differ, which indicated the identity of their tinctorial properties in the compared zones.Conclusion Morphological analysis showed that when juxtaposing and touching the edges of the healing area of the surgical wound without tension, a stable and continuous scar of the fascial duplication is formed, which ensures reliable fusion of the stitched anatomical structures.

Introduction. In recent years, interest in the use of radical prostatectomy (RPE) as one of the components of a multimodal approach in patients with lymphogenous disseminated and metastatic prostate cancer (PCa) has grown significantly. At the same time, the dearth of large randomized trials does not make it possible to use this technique in wide clinical practice outside of clinical trials.Purpose of the study. To evaluate the effectiveness of multimodal therapy using combined chemo-hormonal, surgical and radiation therapy in patients with primary oligometastatic hormone-sensitive PCa.Material and methods. The study included 48 patients with primary oligometastatic prostate cancer who received combination treatment within the internal one-research-center protocol. At the first stage, all patients underwent combined drug therapy with docetaxel (75 mg/m2 intravenously every 3 weeks for 6 courses) and degarelix. Patients who had a decrease in PSA level ≤ 2 ng/ml and registered stabilization of the disease according to radiological examination were treated surgically through RPE with extended pelvic and retroperitoneal lymph node dissection. Radiation therapy was performed only in patients with the presence of bone lesions at a dose of 50-70 Gy to the location of bone metastases in the stage 3 plan of combined multimodal therapy.Results. PCa biochemical relapse was verified in 27 (56.3%) patients during the median follow-up of 10 months. The average time to PSA increase was 9.0 ± 5.7 months (from 1 to 24 months), median — 7 months, Six-month PSA relapse-free survival (PSA-RFS) was 61.2 ± 7.5%; 1-year PSA-RFS — 38.0 ± 8.6%. The average duration before the initiation of hormonal therapy was 12 ± 6.1 months (from 3 to 27 months), median: 10 months. Six-month survival before the drug administration was 72.6 ± 6.8%; twelve-month survival: 40.9 ± 8.7%. About 40% of patients with oligometastatic PCa had no signs of progression and did not receive any other drug therapy for 12 months after completion of protocol treatment.Conclusions. Analysis of the study results demonstrates satisfactory oncological outcomes of the studied treatment option in patients with newly diagnosed oligometastatic hormone-sensitive PCa, as well as a low likelihood of side effects and complications. Nevertheless, it is necessary to continue conducting larger and more structured randomized trials to determine the possibility of applying this therapeutic approach in clinical practice.

Introduction. Simultaneous inhibition of programmed cell death-1 (PD-1)/PD-L1 immune checkpoint and VEGF/VEGFR signaling has a synergistic antitumor effect in preclinical models. This article presents the results of the phase III study JAVELIn Renal 101 (NCT02684006), as well as the experience of using this combination in real clinical practice. Materials and methods. In 2016, the JAVELIn Renal 101 randomized phase III trial (NCT02684006) was launched to compare the efficacy of avelumab and axitinib versus sunitinib in previously untreated patients with metastatic renal cell carcinoma (mRCC). The study included 886 patients randomized 1:1: avelumab + axitinib group (442 patients) and sunitinib group (444 patients). A total of 560 (63.2%) patients had PD-L1 positive tumor expression (PD-L1+): 270 in avelumab + axitinib group and 290 in sunitinib group.Results and discussion. Median progression-free survival was 13.8 versus 7.2 months, respectively (RR for disease progression or death 0.61; 95% CI). In the general population median progression-free survival was 13.8 months versus 8.4 months, respectively (RR 0.69; 95% CI 0.56 to 0.84; p < 0.001). Among those with PD-L1-positive tumor status, the objective response rate was 55.2% in avelumab + axitinib group and 25.5% in the sunitinib group; the median follow-up period for overall survival was 11.6 months and 10.7 months; 37 vs 44 patients died, respectively. Adverse events during treatment occurred in 99.5% of patients in the avelumab + axitinib group and in 99.3% in the sunitinib group. Experience of using the combination of avelumab with axitinib in real practice was presented by British researchers in another study. The study included 44 patients with mRCC who had not previously received drug therapy. The mean follow-up period was 6.9 months (range 0.8–13.5 months). The mean age was 68 years (range 48–81). The obtained clinical data confirmed the results of the JAVELIn Renal 101 study with the high efficacy of avelumab + axitinib combination in patients with mRCC in the first line of drug therapy.Conclusion. The avelumab + axitinib combination is effective in mRCC treatment regardless of ECOG, PD-L1 status and risk group. This combination shows objective rate and PFS increase both in general and PD-L1+ population.

This literature review describes various surgical techniques that reduce the urinary incontinence chance after orthotopic plastic surgery of the bladder by Studer. Satisfactory retention of urine is possible in case of maintaining the maximum length of the urethra, consistency of vesico-urethral anastomosis, sufficient volume of neocystis with low pressure, as well as functional and morphological adaptation of the intestinal wall. The techniques that help to reduce tension in the region of the vesico-urethral anastomosis and pressure in a short mesentery, preservation of functional urethral length by "secondary sphincter" using, attention is paid to some exposure characteristics of the ileum segment of sufficient length for the formation of neocities a satisfactory amount of, performing neotestamentaria during robot-assisted of cystoplasty, comparing the surgical techniques, as well as possible the feasibility of using suture V‑loc. A modified method for forming a robot-assisted anastomosis for laparoscopic operations is described. The results of clinical studies are presented, in one of which the results of modification of the "non-hole" technique are considered, and in the other — the method of temporary tension of the anastomosis zone. The article describes the experience of forming a vesico-urethral anastomosis using a CAPIO cross-linking device, as well as the experience of reconstructing The denonvillier fascia intraoperatively. An artificial device to achieve urinary retention: the artificial urinary sphincter (AUS).

In developed countries, the main methods of research and dynamic monitoring of cystic kidney formations are CT and MRI, but their use is impossible in patients with severe concomitant diseases, as well as in the presence of metal structures, pacemakers, etc. Additionally, taking into account the high dose of radiation exposure when using CT obtained by the patient during dynamic observation, the development of alternative methods is relevant. These include, but not limited to, ultrasound using contrast enhancement, which can be used as an alternative or additional method in primary diagnosis or in the dynamic observation of cystic kidney formations. In the article, the authors provide their own experience with the use of an ultrasound contrast medium for the diagnosis and dynamic observation of complex kidney cysts, as well as the introduction of ultrasound observation using a contrast medium to classify patients according to Bosniak M.A.The study included the results of the use of contrast enhanced ultrasound (CEUS) in 28 patients with various cystic formations of the kidneys. The patients were previously divided into two groups: the first consisted of 13 patients with simple cysts, the second – 15 with suspected complex cysts. As a result of the study, the patients were distributed as follows: 15 patients were classified as Bosniak type I, 7 patients – as type II, 3 - type III, 3 - type IV. The studied CEUS method is simple and effective. The specificity of the method was 78.57%, the accuracy of the method was 85.71%, the predictive value of the positive result was 81.25%, and the predictive value of the negative result was 91.66%. CEUS helps to quickly and accurately conduct differential diagnosis between a simple cyst and a complex one, as well as classify cysts according to M.A. Bosniak.

Prostate cancer (Pca) is the most common urogenital tumour in men. The most common histological form of prostate cancer is acinar adenocarcinoma. Rare morphological types of prostate cancer present an urgent clinical problem due to their aggressive course and the lack of rigorous standards for the management of such patients. Squamous and combined adenosquamous (ASC) prostate cancers are extremely rare histological forms of Pca, occurring in 0.5–1% of cases. The age of patients with these conditions varies from 52 to 79 years. Squamous cell and ASC cancers are among the most aggressive morphological types of prostate cancer. By the time of the diagnosis, most patients develop distant metastases, which are frequently localized in the lymph nodes and bones. In tumours of such a morphological structure, bone metastases are of osteolytic nature. The prognosis is unfavourable due to the rapid metastasis and development of the malignant process. The survival rate of patients averages 16 months after combined treatment. Only 20% of the patients with distant metastases at the time of diagnosis live longer than 6 months. In most cases, squamous cell Pca manifests itself through local symptoms, such as dysuria, bone pain and hematuria. The vast majority of patients have a normal level of prostate-specific antigen (PSA) in serum. Since ASC Pca is a fairly rare form of prostate cancer, no treatment standards have thus far been developed. Hormone therapy, chemotherapy and radiation therapy are believed to either be ineffective or show low efficacy in the treatment of ASC Pca. In cases where ASC Pca is localized, surgical treatment in the amount of radical prostatectomy, cystoprostatectomy or simultaneous surgical interventions with rectal resection can significantly extend the life of such patients. The article presents the clinical case of managing a patient with ASC Pca.

Pazopanib (Votrient®) is an oral small-molecule multi-kinase inhibitor that predominantly inhibits vascular endothelial growth factor receptor-1, -2 and -3, platelet-derived growth factor receptor-α and -β and the stem cell factor receptor c-Kit. In preliminary experiments using mouse and rabbit models of angiogenesis, pazopanib inhibited angiogenesis caused by a combined vascular endothelial growth factor and a major fibroblast growth factor. Although the drug was developed as a therapeutic multi-tumour agent, it is currently approved in many countries for the treatment of advanced soft tissue sarcoma and renal cell carcinoma (RCC). In multicentre, randomized trials of the efficacy of pazopanib as a first-line therapy in patients with metastatic RCC, progression-free survival (PFS) was significantly greater in pazopanib recipients than in cytokine recipients and pazopanib was noninferior to sunitinib with respect to time to disease progression. In addition, side effects such as liver dysfunction and hypertension can be usually managed, and pazopanib is likely to be a more preferred cost-effective option and shows better quality-of-life compared to other alternative drugs.

Determination of indications for performing reconstructive and plastic surgical interventions in stricture of UPS is a difficult task. When making an incorrect decision, the treatment can be ineffective. Functional and anatomical preservation of the kidney can significantly affect the outcome of the operation.Purpose. Evaluation of the effectiveness of laparoscopic plastic surgery of stricture of UPS, depending on the anatomical and functional state of the ipsilateral kidney.Material and method. The results of treatment of 134 patients, who underwent for the period from 2012 to 2015 the different types of reconstructive surgical interventions for stricture of the pelvic-ureteral segment (Calp de Virde scrappy plastic surgery, Andersen-Heinz ureteropyelanastomosis, and antineoplastic ureteropyeloanastomosis), were analyzed. To analyze the effectiveness of the treatment, in the preand postoperative period, the following parameters were evaluated: the presence of pain syndrome, the presence of pyeloectasia, the functional state of the renal parenchyma (according to radioisotope renography), and the absence of recurrence of the UPS stricture.Result. The overall efficacy of laparoscopic UPS reconstruction was 94.7%. The results of treatment did not depend on the chosen technique of operative intervention. In this case, the effectiveness of the treatment was dependent on the initial deficiency of kidney function: the best results were seen in patients with kidney function deficiency of less than 25%, and the proportion of ineffective interventions was highest among patients with a deficit of more than 75%. The degree of dilatation of the pelvis in the postoperative period was also associated with preoperative indicators of kidney function deficiency, this may be due to the presence of cup-pelvis-plating system atony.Conclusion. Thus, the results of our work demonstrated the high efficiency of laparoscopic plastics of UPS. The effective- ness of treatment is determined by the timeliness of the intervention. As a basic prognostic criterion for the effective- ness of the forthcoming intervention, the degree of deficiency of the kidney function should be considered.

The results of multicenter trial for efficacy of fluorescence diagnosis for bladder cancer with agent hexasens (SSC Scientific Research Institute Organic Intermediates and Dyes, Russia) based on hexyl ester of 5-aminolevulinic acid compared with routine cystoscopy are represented in the article. The study included 124 patients. All patients had intravesical instillation of 50 ml of 0,2% hexasens. The exposure time accounted for 1-2 h. After removal of the drug from bladder standard cystoscopy followed by fluorescence diagnosis was performed in every patient. During the local fluorescence spectroscopy the intravesical instillation of the agent hexasens was shown to induce selective accumulation of photoactive protoporphyrin IX in tumor cells comparing with intact bladder mucosa. During 1 h after intravesical instillation of hexasens solution the level of fluorescence of hexasens-induced protoporphyrin IX in the tumor was higher than that in surrounding intact mucosa at average in 5.8 fold. As compared with results of standard cystoscopy, fluorescence diagnosis improved the sensitivity of the method by 24.4% (from 75.6% to 100%), the accuracy – by 15.2% (from 83.3% to 98.5%) and negative predictive value – by 33.5% (from 66.5% to 100%). Fluorescence diagnosis gave an opportunity to detect additional tumor foci, which were invisible in white light, in 27.4% of patients. For fluorescence diagnosis in 4.0% of patients false-positive fluorescence of bladder mucosa was detected that was probably due to inflammation. None of patients received active dose of the drug hexasens had adverse reactions, changes in general well-being and blood and urine parameters. According to the results of the study fluorescence diagnosis with hexasens for bladder cancer is recommended for use in clinical practice.

Renal cell carcinoma (RCC) occupies one of the leading places in the world for morbidity among malignant neoplasms of the genitourinary system. The frequency of occurrence of bilateral RCC according to different authors is 2–6% of the total population of patients with RCC. Currently, the only effective method of treatment of bilateral RCC is surgical treatment. Patients with bilateral RCC are at high risk of dev eloping of local recurrence or progression of the disease after organ-preserving surgeries, which is why the surgeon is faced with a choice between a high risk of developing renal failure or relapse and/or progression of the disease, depending on the extent of the surgical intervention. According to the literature, in patients with bilateral RCC there was an increase in the incidence of papillary variant of RCC up to 19% and the presence of multifocal lesion. Surgical treatment of bilateral RCC is the only effective method to achieve satisfactory oncological results at a low incidence of complications. The m ost justified option for the treatment of bilateral RCC is the implementation of bilateral organ-preserving treatment, which allows achieving the optimal functional results. This article presents a clinical case of successful surgical treatment of a patient with bilateral RCC with multiple tumors.

The results of multicenter trial for efficacy of fluorescence diagnosis for bladder cancer with agent hexasens (SSC Scientific Research Institute Organic Intermediates and Dyes, Russia) based on hexyl ester of 5-aminolevulinic acid compared with routine cystoscopy are represented in the article. The study included 124 patients. All patients had intravesical instillation of 50 ml of 0,2% hexasens. The exposure time accounted for 1-2 h. After removal of the drug from bladder standard cystoscopy followed by fluorescence diagnosis was performed in every patient. During the local fluorescence spectroscopy the intravesical instillation of the agent hexasens was shown to induce selective accumulation of photoactive protoporphyrin IX in tumor cells comparing with intact bladder mucosa. During 1 h after intravesical instillation of hexasens solution the level of fluorescence of hexasens-induced protoporphyrin IX in the tumor was higher than that in surrounding intact mucosa at average in 5.8 fold. As compared with results of standard cystoscopy, fluorescence diagnosis improved the sensitivity of the method by 24.4% (from 75.6% to 100%), the accuracy – by 15.2% (from 83.3% to 98.5%) and negative predictive value – by 33.5% (from 66.5% to 100%). Fluorescence diagnosis gave an opportunity to detect additional tumor foci, which were invisible in white light, in 27.4% of patients. For fluorescence diagnosis in 4.0% of patients false-positive fluorescence of bladder mucosa was detected that was probably due to inflammation. None of patients received active dose of the drug hexasens had adverse reactions, changes in general well-being and blood and urine parameters. According to the results of the study fluorescence diagnosis with hexasens for bladder cancer is recommended for use in clinical practice.

The results of multicenter prospective trial for efficacy of combined modality treatment: transurethral resection (TUR) + photodynamic therapy (PDT) with alasens for bladder cancer are represented in the article. Trials were organized by Research Institute of Organic Intermediates and Dyes and conducted according to clinical protocol approved by Ministry of Health of Russia, at the sites of leading Russian cancer clinical centers. The trial included 45 subjects with verified diagnosis of non-muscle-invasive bladder cancer. Patients underwent TUR of bladder with simultaneous PDT as anti-relapse treatment. Alasens was administered to patients as intravesicular instillation of 3% solution in volume of 50 ml with 1.5–2h exposure (prior to TUR). TUR was performed after instillation. PDT session was conducted immediately after the completion of TUR on a single occasion by means of combined local irradiation on tumor bed with diffuse irradiation on whole urinary bladder mucosa (light dose of local irradiation – 100 J/cm2, diffuse irradiation – 20 J/cm2). Good tolerance of the treatment was noticed, there were no complications. Among 45 patients included in the trial, 35 (78%) completed 12 month protocol follow-up without relapse. The recurrence of bladder tumor was registered in 10 (22%) cases 6–12 months after TUR+PDT including 3 patients with recurrence 6 months after treatment, 3–9 months and 4–12 months. These patients underwent repeated TUR, whereafter their follow-up in the settings of the clinical trial was disposed. Thus, PDT with alasens after TUR allowed to decrease the recurrence rate of non-muscle-invasive bladder cancer for 1st year after treatment to 22% versus 40–80% for TUR as monotherapy according to literature data. The obtained results were comparable by efficiency with TUR combined with methods of adjuvant treatment for bladder tumors (the recurrence rates for 1-year follow-up after TUR+chemotherapy – 36–44%, after TUR+BCG – 20–59%).

The results of multicenter prospective trial for efficacy of combined modality treatment: transurethral resection (TUR) + photodynamic therapy (PDT) with alasens for bladder cancer are represented in the article. Trials were organized by Research Institute of Organic Intermediates and Dyes and conducted according to clinical protocol approved by Ministry of Health of Russia, at the sites of leading Russian cancer clinical centers. The trial included 45 subjects with verified diagnosis of non-muscle-invasive bladder cancer. Patients underwent TUR of bladder with simultaneous PDT as anti-relapse treatment. Alasens was administered to patients as intravesicular instillation of 3% solution in volume of 50 ml with 1.5–2h exposure (prior to TUR). TUR was performed after instillation. PDT session was conducted immediately after the completion of TUR on a single occasion by means of combined local irradiation on tumor bed with diffuse irradiation on whole urinary bladder mucosa (light dose of local irradiation – 100 J/cm2, diffuse irradiation – 20 J/cm2). Good tolerance of the treatment was noticed, there were no complications. Among 45 patients included in the trial, 35 (78%) completed 12 month protocol follow-up without relapse. The recurrence of bladder tumor was registered in 10 (22%) cases 6–12 months after TUR+PDT including 3 patients with recurrence 6 months after treatment, 3–9 months and 4–12 months. These patients underwent repeated TUR, whereafter their follow-up in the settings of the clinical trial was disposed. Thus, PDT with alasens after TUR allowed to decrease the recurrence rate of non-muscle-invasive bladder cancer for 1st year after treatment to 22% versus 40–80% for TUR as monotherapy according to literature data. The obtained results were comparable by efficiency with TUR combined with methods of adjuvant treatment for bladder tumors (the recurrence rates for 1-year follow-up after TUR+chemotherapy – 36–44%, after TUR+BCG – 20–59%).

The method of fluorescence visualization of bladder tumors combined with fluorescence spectroscopy developed in P.A. Herzen MCRI is described. The efficacy of the method was proved by results of diagnostics in 198 patients with superficial bladder cancer. In the study group 67 patients had primary tumor, 131 patients had recurrence of superficial bladder cancer after previous treatment. In 3.5% patients the lesion was determined as carcinoma in situ, in 29.5% – non-invasive papillary carcinoma, bladder cancer with invasion into submucosal layer of bladder wall occurred in 67% of cases. Diagnostics was performed 1.5–2 h after instillation of 50 ml 3% solution of alasens into bladder. The data analysis was made with calculation of the diagnostic parameter and value of tumor/normal mucosa fluorescence contrast. The total number of fluorescence spectra accounted for 528. All determined areas of fluorescence were studied morphologically. During fluorescence spectroscopy 53 areas of fluorescence were determined on visually intact mucosa under white light, showed high values of diagnostic parameter. Morphological study proved severe dysplasia (3%), carcinoma in situ (95%) and bladder cancer (2%). Correlation between data of local fluorescence spectroscopy and morphological study of biopsy specimen was assessed, values of diagnostic parameter, характеризующих intact urothelium, areas of inflammation and moderate dysplasia, severe dysplasia and bladder cancer were estimated. Local fluorescence spectroscopy combined with visual assessment of fluorescence image allowed to increase specificity of cystoscopy from 70% to 85%, total accuracy – from 80% to 86%, with improvement of predictive value for positive result from 0,67 to 0,94.

The method of fluorescence visualization of bladder tumors combined with fluorescence spectroscopy developed in P.A. Herzen MCRI is described. The efficacy of the method was proved by results of diagnostics in 198 patients with superficial bladder cancer. In the study group 67 patients had primary tumor, 131 patients had recurrence of superficial bladder cancer after previous treatment. In 3.5% patients the lesion was determined as carcinoma in situ, in 29.5% – non-invasive papillary carcinoma, bladder cancer with invasion into submucosal layer of bladder wall occurred in 67% of cases. Diagnostics was performed 1.5–2 h after instillation of 50 ml 3% solution of alasens into bladder. The data analysis was made with calculation of the diagnostic parameter and value of tumor/normal mucosa fluorescence contrast. The total number of fluorescence spectra accounted for 528. All determined areas of fluorescence were studied morphologically. During fluorescence spectroscopy 53 areas of fluorescence were determined on visually intact mucosa under white light, showed high values of diagnostic parameter. Morphological study proved severe dysplasia (3%), carcinoma in situ (95%) and bladder cancer (2%). Correlation between data of local fluorescence spectroscopy and morphological study of biopsy specimen was assessed, values of diagnostic parameter, характеризующих intact urothelium, areas of inflammation and moderate dysplasia, severe dysplasia and bladder cancer were estimated. Local fluorescence spectroscopy combined with visual assessment of fluorescence image allowed to increase specificity of cystoscopy from 70% to 85%, total accuracy – from 80% to 86%, with improvement of predictive value for positive result from 0,67 to 0,94.

The case of successful photodynamic therapy in patient with erythroplasia of Queyrat is re-ported. The treatment was performed under spinal anesthesia after local application of alasens gel. The exposition of the drug was 5 h with light dose – 150 J/cm2. There were no complications in the post-treatment period. The complete tumor regression was noticed 3 months after treatment. The follow-up period accounted for 1.5 years. Thus, photodynamic therapy is efficient in terms of organ-preserving treatment in patients with penile cancer.

The case of successful photodynamic therapy in patient with erythroplasia of Queyrat is re-ported. The treatment was performed under spinal anesthesia after local application of alasens gel. The exposition of the drug was 5 h with light dose – 150 J/cm2. There were no complications in the post-treatment period. The complete tumor regression was noticed 3 months after treatment. The follow-up period accounted for 1.5 years. Thus, photodynamic therapy is efficient in terms of organ-preserving treatment in patients with penile cancer.

Purpose. To evaluate pharmacokinetics, pharmacodynamics, safety, immunogenicity and efficacy of intravenous infusions of BCD-100 (JSC “BIOCAD”, Russia) in increasing doses. Patients (materials) and methods. Patients with advanced malignant tumors of various localizations without severe somatic pathology were consistently included in cohorts receiving the BCD-100 drug in monotherapy at different doses (0.3, 1.0, 3.0 and 10 mg/kg) every 2 weeks for at least 85 days. Safety, pharmacokinetics, pharmacodynamics, immunogenicity and efficacy of the therapy were assessed. Results. 15 patients were included in the study. The vast majority of adverse events were represented by deviations in the results of laboratory tests of 1-2 grade, there was only one confirmed case of dose-limiting toxicity (autoimmune thyroiditis of 2 grade). Pharmaco kinetic parameters were standard for drug based on monoclonal antibodies of class IgG1. The saturation of PD-1 receptors by BCD-100 was high (90-100%) at all dose levels. 1 partial response to antitumor therapy and 3 stabilization cases according to irRC criteria were registered. conclusion. BCD-100 demonstrated a favorable profile of safety and immunogenicity, expected pharmacokinetic parameters allowing the drug to be administered once every 2 or 3 weeks, high pharmacodynamic parameters and the presence of antitumor activity.

Prostate cancer is one of the most actual problems of modern oncourology. Castrate-refractory prostate cancer (CRPC) is extremely he-terogeneous disease and treatment conception should be individualized in every patient. Therapeutic options in CRPC include 2nd line hormonal therapy, chemotherapy, vaccines, target therapy, radiopharmaceuticals, etc. However, clear algorithm of treatment in using of 1st or 2nd line drugs nowadays is absent. In the article modern concept of treatment of patients with CRPC is present, moreover prognostic factors of therapeutic response are analyzed.

Хотя в 70–80% случаев рак почки диагностируются на стадии локализованного опухолевого процесса, более чем у 1/2 пациентов после оперативного лечения развиваются метастазы [4]. Прогноз течения заболевания при развитии метастатического процесса у больных почечно-клеточным раком крайне пессимистичный: при отсутствии специфического лечения период до прогрессирования составляет 2–4 мес, а средняя продолжительность жизни после выявления метастазов не более 10–13 мес.Несмотря на резистентность к цитостатической и гормональной терапии, опухоли почки обладают определенной чувствительностью к иммуногенным воздействиям. Известны феномен "спонтанной регрессии" метастазов рака почки, а также случаи длительной ремиссии при отсутствии специфического лечения, что косвенно свидетельствует об иммунозависимости опухолевых клеток [9, 10]. Иммунотерапия цитокиновыми препаратами (интерферон-α – ИФН-α и интерлейкин-2 – ИЛ-2) является в настоящее время основным методом лечения метастатического рака почки.Новым перспективным направлением в лечении больных метастатическим раком почки является применение таргетных препаратов, которое позволяет повысить эффективность терапии у этой категории пациентов. Препарат сорафениб (Нексавар), являющийся мультикиназным ингибитором, влияющим на ангиогенез и пролиферацию опухолевых клеток, приводит к достоверному улучшению безрецидивной выживаемости больных распространенными формами почечно-клеточного рака и обладает хорошей переносимостью, не ухудшая качества жизни пациентов.

Рак предстательной железы (РПЖ) является в настоящее время одним из наиболее распространенных видов злокачественных новообразований в мире. Дальнейшее прогрессирование болезни приводит к потере чувствительности к андрогенным воздействиям, после чего развивается гормонорефрактерная стадия опухолевого процесса (гормонорефрактерный рак предстательной железы - ГРРПЖ). Средняя продолжительность жизни больных РПЖ на этом этапе не превышает 6-12 мес. Лечение ГРРПЖ является сложным и многоэтапным процессом. Эстрацит, сочетая в своем механизме действия цитостатический противоопухолевый эффект и гормональный эффект, с успехом может применяться на всех этапах терапии ГРРПЖ, общий объективный ответ на лечение составляет 40-50%. Благодаря незначительной миелосупрессивной токсичности и синергизму с различными противоопухолевыми агентами эстрамустин является базисным препаратом для проведения различных схем полихимиотерапии. Таким образом, терапия Эстрацитом и комбинированная терапия с его применением являются методами выбора лечения ГРРПЖ.

Рак предстательной железы (РПЖ) - одно из наиболее распространенных заболеваний у мужчин пожилого возраста. При наличии костных метастазов, а также при развитии резистентности к гормональной терапии, вероятность осложнений со стороны скелета возрастает.В связи с актуальностью проблемы в 2002 г. было решено провести Российское многоцентровое исследование по оценке эффективности зометы у больных РПЖ с костными метастазами.В исследовании участвовало 9 исследовательских центров. Урологи, онкологи в настоящее время имеют в своем арсенале эффективный препарат "Зомета", который позволяет длительное время стабилизировать состояние костной системы и снижать число патологических осложнений со стороны скелета. Зомета одобрена Фармкомитетом МЗ РФ для лечения больных с литическими, бластическими и смешанными метастазами в кости. Все указанное подтверждает необходимость широкого использования зометы в лечении больных РПЖ.

Рак предстательной железы (РПЖ) в настоящее время является одним из наиболее широко распространенных злокачественных новообразований у мужчин.Гормонотерапия является основным методом лечения генерализованного РПЖ.Наибольший интерес привлекает монотерапия с использованием нестероидного антиандрогена бикалутамида (касодекс).При анализе результатов лечения 480 больных с местнораспространенным РПЖ отмечены одинаковые показатели выживаемости и продолжительности ремиссии в группе пациентов, получавших касодекс, и в группе больных, перенесших кастрацию. Риск умереть во время лечения у больных, получавших касодекс, оказался на 7% меньше, чем у больных после двусторонней орхидэктомии или лечения агонистами ЛГРГ, качество жизни больных в группе монотерапии бикалутамидом также оказалось значительно более высоким. Таким образом, монотерапия касодексом в дозе 150 мг может быть выбрана в качестве метода лечения больных местнораспространенным и метастатическим РПЖ, желающих сохранить потенцию, но при этом пациенты должны быть хорошо информированы о всех применяемых способах гормонотерапии и их эффективности.