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The study objective is to evaluate effectiveness and tolerability of 1st line combination immuno-oncological therapy with nivolumab and ipilimumab in patients with metastatic renal cell carcinoma (mRCC) in clinical practice.Materials and methods. The study included 38 patients with mRCC who received combination immunotherapy between July of 2019 and September of 2021. Median follow-up duration was 8 (2-25) months. Mean age of the patients was 58.3 (20-85) years. Previously 22 (57.9 %) patients underwent surgical treatment. Unfavorable physical status 2-3 per the ECOG scale was observed in 10 (26.3 %) patients. Clear-cell type of renal cell carcinoma was diagnosed in 34 (89.6 %) patients, non-clear-cell types in 4 (10.4 %). Sarcomatoid component in the tumor was detected in 8 (21.0 %) patients. G3-4 mRCC variant was verified in 16 (42.1 %) patients. Poor prognosis per the IMDC (International Metastatic Renal Cell Carcinoma Database Consortium) scale was identified in 16 (42.1 %) patients, intermediate -in 20 (52.6 %) patients. All 4 administrations of combination immunotherapy were received by 29 (76.3 %) patients.Results. For median follow-up duration of 8 (2-25) months, 23 (60.5 %) patients continue treatment, 15 (39.5 %) completed therapy with nivolumab and ipilimumab due to various reasons including progression in 11 (28.9 %), death in 2 (5.3 %), intolerable toxicity in 2 (5.3 %) cases. Median duration of combination immunotherapy was 9 (2-24) months. Subsequent antitumor therapy was administered to 3 (7.9 %) patients. During induction course immune-mediated adverse event (grade III-IV hepatitis) developed in 3 (7.9 %) patients. Adverse events were observed in 81.6 % of patients, including grade III-IV in 23.7 % of patients. Objective response was observed in 44.8 % of cases, complete response in 5.3 % of cases, partial response in 39.5 % of cases; controlled disease was achieved in 84.3 % of patients. Median progression-free survival and overall survival were 8 months.Conclusion. In our study despite large number of patients with poor prognosis and poorly differentiated tumors, 64.0 % of patients are alive and 60.5 % of patients continue treatment without disease progression after 18 months of combination immunotherapy. Progression-free survival was significantly affected by sarcomatoid component in the tumor, number of unfavorable factors per the IMDC scale, best response per RECIST 1.1; overall survival was significantly affected by sarcomatoid component in the tumor, sum of measurable lesions, number of unfavorable factors per the IMDC scale, best response per RECIST 1.1, and presence of symptomatic metastases in the brain.

Objective: 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 is planned to include 200 patients with a documented diagnosis of nmCRPC from 2019 to 2020. The interim report has included data on 108 patients from 13 centers located in different regions of the Russian Federation. The median age of the patients was 73 (55—90) years.Results and conclusion. When the diagnosis of nmCRPC was made, the median prostate specific antigen was 8.23 (0.17—116.9) ng/ml, and the prostate specific antigen doubling time was 6 (1—50) months. When diagnosed nmCRPC, 86 patients (79.6 %) underwent a change of therapy, of which 42 % were prescribed modern regimens containing the new generation non-steroid antiandrogens (apalutamide, enzalutamide).

Objective: The morbidity of multiple urological malignances is steadily grown. Incidental prostate cancer in patients with bladder cancer seems to be fairly often. This is one of the reasons of that the question of partial sparing of prostate in patients undergone radical cystoprostatectomy is still discussable. Purpose: The present study is designed to evaluate the incidence of simultaneous prostate and bladder cancer in patients undergoing radical cystoprostatectomy in Moscow Scientific Research Institute of Oncology.Materials and methods: From 1994 to 2005, 113 men (mean age 59,5 years), with no evidence of prostatic malignancy on preoperative clinical and biochemical assessment, underwent cystoprostatectomy for TCC of the bladder in our institute. The bladder was adequately sampled and the entire prostate sectioned at 5-mm intervals and examined histologically, in order to identify unsuspected prostatic cancer (PCa).Results: 10 out of 113 patients (8,8%) were found to have PCa. Four (3,5%) had cr. in situ, five (4,4%) had high grade prostatic intraepithelial neoplasia (PIN). All tumors were clinically significant, except cr. in situ and PIN. Almost all tumors (7,9%) were organ confined (pT2a—T2c), except one (0,9%), which was locale advanced (pT3a). Glaeson score was 2—4 in 5 (26,3%) and 5—7 in 5 (26,3%).Conclusions: Incidental PCa is quite a common finding in cystoprostatectomy specimens of bladder cancer patients. This demands careful and complete excision of the prostate in patients with muscular-invasive bladder cancer.

Objective. To define the prognostic value of the growth rate (GR) in the level of prostate-specific antigen (PSA) after radical prostatectomy (RPE).Materials and methods. The data on 48 patients who underwent RPE in 1999—2006, in whom a biochemical recurrence was verified on the basis of the results of PSA monitoring, were retrospectively analyzed. PSA GR was calculated for each patient. Correlation analysis using the major predictors was also made.Results. During a follow-up, overall and tumor-specific survivals were 91,7 and 93,8%, respectively. Five-year relapse-free survival calculated by the Kaplan-Meier method was 67%. PSA GR proved to be an independent predictor of relapse-free survival. Generalization was more common at a PSA GR of > 2 ng/ml/year while a PSA GR of 1,0—2,0 ng/ml/year is more typical of the development of a localized recurrence.Conclusion. Analysis of post-PRE PSA GR makes it possible to predict the postoperative course of prostate cancer, to reveal its early progression, and to perform therapy in due time. For early diagnosis of its clinical progression, it is expedient to assess a combination of predictors, by making up progression-risk groups.

Prostate cancer (PC) is one of the most pressing problems of modern oncology due to high worldwide morbidity for this pathology. Annually, more than 1,100,000 new cases of PC are diagnosed worldwide. The main treatment method for patients with locally advanced and/or metastatic PC is hormone therapy. Androgen deprivation allows to achieve disease stabilization in more than 90 % of patients, but mean time to progression after hormone therapy in patients with metastatic PC is about 2 years. Patients with cancer progression and preserved castration level of testosterone transition to the stage of so-called castration-resistant prostate cancer (CRPC). Advanced CRPC not only has poor prognosis, it also significantly decreases quality of life of the patients. CRPC patient cohort is extremely heterogenous and included patients both with factors of favorable prognosis and fulminant course of the disease. Unfavorable prognostic factors for patients with metastatic CRCP are short response time for initial hormone therapy (

The majority of patients with metastatic renal cell carcinoma (mRCC) are in the groups of favorable or moderate prognosis per the MSKCC (MemorialSloan-KetteringCancerCenter) criteria, but in 20–30 % of poor-prognosis patients aggressive, rapidly progressing mRCC is observed. Despite improved prognosis in mRCC patients due to targeted therapy, this patient group remains hard to treat with overall survival 6 months) was higher in the temsirolimus (32.1 %) and combination (28.1 %) groups compared to the IFN-α group (15.5 %; р

Prostate cancer (PC) is one of the most urgent problems of modern urologic oncology in Russia because of a steady rise in morbidity and mortality rates associated with this disease. Radical prostatectomy (RP) and external beam radiotherapy (EBRT) or brachytherapy are mainstay treatments in patients with localized and locally advanced PC. Just the same, the rate of lymphogenic disease progression after radical treatment is as high as 15–40 %. At the same time, a search for a tumor focus leading to an increase in the marker is extremely important. If a local recurrence is detected after previous RP, there may be salvage EBRT. After verifying the relapse after salvage EBRT or brachytherapy, RP may be recommended to patients in the specialized centers having appropriate experience with this type of surgery. In patients with distant metastases, palliative hormonal therapy has been the only conventional method so far. Nonetheless, in a considerable number of patients, a marker recurrence may be associated with the so-called oligometastatic progression of the disease, in which the number of detected metastatic foci is minimal. The clinical introduction of promising and precise diagnostic methods having high sensitivity and specificity even with the minimal levels of prostate-specific antigen, such as magnetic resonance imaging and positron tomography, could substantially increase the number of detectable patients with oligometastases and propose new therapeutic conceptions for the treatment of this contingent of patients. Recently, in the literature there have been increasingly more works suggesting the possibility of using local treatments (surgery or radiotherapy) in patients with oligometastases when the disease progresses after radical treatment. The results of investigations show that a personalized approach and surgical or radiation treatments in selected patients make it possible to increase survival prior to the use of hormonal treatment and, in a number of cases, to completely abandon the latter. The paper gives a review of the literature data dealing with this problem.

Over 200,000 new cases of renal-cell carcinoma (RCC) are notified worldwide every year. Examinations diagnose metastatic RCC (mRCC) in 25 % of primary patients; and after radical surgery 20–40 % of the patients are further diagnosed with disease progression and metastases. Randomized trials have demonstrated the efficacy of tyrosine kinase inhibitors in treating mRCC. Clinical trials are conducted on a carefully selected population of patients; the latter have generally clear-cell RCC without brain metastases and a good somatic status. In real clinical practice, the population of patients with mRCC is more heterogeneous; there are patients with non-clear cell mRCC, brain metastases, and an ECOG somatic status > 1; this raises the question as to whether it is effective and appropriate to use target agents in these patient groups.The paper gives the data of performed clinical trials using sunitinib with expanded inclusion criteria and those of non-randomized trials that have proven the clinical efficacy of the drug in patients with a poor prognosis, non-clear cell mRCC, and brain metastases, as well as in the elderly. Despite lower objective response rates, the progression-free survival rates in this category of patients have proven to be comparable to those in patients with clear cell mRCC.

Prostate cancer (PC) is the second most common cancer and the fifth highest malignancy mortality rate in men worldwide. Although PC is detectable in 15-20% of men during life, its death risk is only about 3%. This means that not all PC cases require the same management tactics. The given review analyzes the current investigations searching for molecular biological markers to predict the course of PC and to choose its treatment policy, including that in the development of resistance to androgen-deprivation therapy.

Prostate cancer (PC) is one of the most burning problems of modern urologic oncology. Hormonal therapy (HT) using medical castrationremains a basic therapy for metastatic PC. HT with a novel class of luteinizing hormone-releasing hormone (LHRH) receptor antagonists isa promising and effective castration treatment option that has a number of significant advantages over LHRH analogues. The paper reviews the results of trials comparing the efficiency and adverse reactions of HT using LHRH antagonists and analogues and gives those of a Russian multicenter study covering the countrywide experience with degarelix.

Background. There is a global increase in the incidence of renal cell carcinoma (RCC); more than 200 thousand new cases are recordedevery year. Despite the high (40–60 %) detection rate for localized RCC, the incidence of locally advanced and metastatic RCC (mRCC)remains high. Tyrosine kinase inhibitors, such as sorafenib, sunitinib, bevacizumab, and pazopanib, versus cytokine therapy or placebodemonstrated their efficacy in the treatment of mRCC during randomized trials. A randomized Phase III AXIS trial evaluating the efficacy of axitinib in direct comparison with sorafenib in patients with progressive mRCC during first-line systemic therapy has become one of the first studies comparatively investigating the targeted drugs.Subjects and methods. The trial enrolled 723 patients with mRCC from 175 centers in 22 countries in the period September 2008 to July 2010. The patients were randomized 1:1 to either axitinib (n = 361) or sorafenib (n = 362). Of them, 389 (54 %) patients had previously received sunitinib, 251 (35 %) cytokines, 59 (8 %) bevazisumab, and 24 (3 %) temsirolimus.Results. Median overall survival (OS) was 20.1 months (95 % confidence (CI) 16.7–23.4) in the axitinib group and 19.2 months (CI 17.5–22.3) in the sorafenib group (odds ratio (OR) 0.969; 95 % CI 0.800–1.174; p = 0.374). According to the investigator assessments, median progression-free survival was 8.3 months (95 % CI 6.7–9.2) in the patients who took axitinib and 5.7 months (CI 4.7–6.5) in those who received sorafenib (OR 0.656; 95 % CI 0.552–0.779; p < 0.0001). The most common grade III adverse reactions related to axitinib included hypertension (n = 60 (17 %)), diarrhea (n = 40 (11 %)), and fatigability (n = 37 (10 %)). The grade III adverse reactions associated with sorafenib included palmoplanar syndrome (n = 61 (17 %)), hypertension (n = 43 (12 %)), and diarrhea (n = 27 (8 %)). A detailed analysisshowed that the high registration rate of axitinib-induced hypertension was a significant prognostic factor of the efficiency of targeted therapy. Median OS in patients with hypertension developing within 12 weeks after randomization and a diastolic blood pressure (BP) ≥ 90 mm Hg was significantly longer than in those with a diastolic BP of < 90 mm Hg: 20.7 months (95 % CI 18.4–24.6) versus 12.9 months (CI 10.1–20.4) in the axitinib group (р = 0.0116) and 20.2 months (95 % CI 17.1–32.0) versus 14.8 months (95 % CI 12.0–17.7) in the sorafenib group (р = 0.0020). During a multivariate analysis, the prognostic factors associated with short-term OS included a previous treatment option (cytokines or sunitinib), ECOG somatic status = 1; a less than 1‑year interval from diagnosis to treatment initiation in the AXIS trial; more thanone metastatic focus; hepatic metastases; skeletal metastases; a hemoglobin level below the lower limit of the normal range; a corrected calcium level of > 10 mg / dl; a lactate dehydrogenase level 1.5‑fold above the upper limit of the normal range, and alkaline phosphatase or neutrophil levels greater than the upper limit of the normal range.Conclusion. Axitinib is one of the first targeted drugs, which has demonstrated its efficacy in direct comparison with the other targeted agent sorafenib within the framework of the randomized Phase III AXIS trial in patients with progressive mRCC during first-line systemic therapy. Axitinib versus sorafenib significantly increased median progression-free survival rates in the general population of patients and in those who had previously received therapy with cytokines or sunitinib (p < 0.0001). Axitinib has a satisfactory toxicity profile and the high registration rate of hypertension associated with the drug is a significant prognostic factor for the efficiency of targeted therapy, as shown by the detailed analysis. To comply with the guidelines for monitoring BP and correcting hypertension permits long-term and effective targeted axitinib therapy.

Leuproprelin acetate (Lucrin-depot) is an efficacious and safe luteinizing hormone-releasing hormone analogue, the efficiency of which has been proven in a number of large clinical studies. The agent exhibits a sustained release, is easy-to-use and well-tolerated, and causes minimal side effects. Lucrin-depot may be recommended for use as alone and in combination with other hormonal agents in patients with prostate cancer if androgenic deprivation is indicated.

Prostate cancer (PC) is one of the urgent problems of modern urological oncology. The incidence of this pathology is steadily growing worldwide. Despite the fact that PSA diagnosis is extensively used and programs for the early detection of this disease are introduced, the rate of dia gnosis of advanced PC forms remains high. Furthermore, a number of aspects of therapy for this disease remain controversial so far. The 7 th Congress of the Russian Society of Urological Oncologists, which dealt with some issues of combination therapy for locally advanced PC, was held in Moscow in October 3 to 5, 2012. The paper covers a number of controversial issues in the management of patients with PC in different clinical situations.

The main radical treatments for patients with prostate cancer (PC) are radical prostatectomy (RPE) and radiotherapy. At the same time pelvic lymphadenectomy (PLAE) in patients with PC is an important diagnostic step during both surgical and radiation treatments. The main goal of PLAE is to evaluate the pelvic lymph nodes. The paper gives the data of a number of trials of the efficiency of RPE with extended PLAE and adjuvant hormonal therapy.

Prostate cancer (PC) is one of the most pressing problems of urologic cancer due to higher morbidity from this pathology worldwide. Treatment policy in PC patients is determined by the extent of a cancer process. Radical therapy for metastatic PC is impossible, hence this patient group is considered eligible for palliative hormonal or chemotherapy. To choose the optimal treatment for patients with hormone-refractory PS (HRPS) is an intricate problem regarding particularly patients with asymptomatic HRPS and those with progressive cancer after chemotherapy with docetaxel. In this instance, the treatment policy is a matter of discussion and is not well defined. The paper considers the use of somatostatin analogues as an alternative to drug therapy for patients with HRPS. Octreotide is one of the most popular drugs of this group. The agent may be used to treat patients with HRPS both before and after systemic cytotoxic therapy. Octreotide therapy is effective and safe; its side effects are minimal and it is well tolerated in patients.

Renal cell carcinoma (RCC) is one of the most urgent topics in modern oncourology. This is attributable to the high morbidity and mortality rates associated with this pathology. Renal dystopia is a rather rare developmental anomaly. The literature data describing cases of the diagnosis and treatment in patients with dystopic kidney malignancies are scarce. Moreover, if a tumor is present in the solitary dystopic kidney, it is often extremely difficult to perform an organ-saving operation for a number of features of the anatomic structure of the dystopic kidney and its vascular architectonics. The paper describes a clinical case of S-shaped crossed dystopic kidney resection in a patient with RCC.

Prostate cancer (PC) is one of the most common male cancer diseases. Pelvic lymphadenectomy (PLAE) is an important diagnostic stage during both surgery and radiotherapy. The main goal of PLAE is to evaluate the pelvic lymph nodes (LN), which makes it possible to define the prognosis of the disease and to choose the most rational treatment policy. The paper analyzes the results of treating 298 moderate-to highrisk circumscribed and locally advanced PC patients undergoing prostatectomy or extended PLAE at the Department of Oncourology, P.A. Herzen Moscow Oncology Research Institute. The detection rate for LN metastases and their site are estimated and the risk for complications due to extended PLAE analyzed.

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 Federation 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.Results. The median follow-up was 9 months (interquartile range (IQR) 6–13 months). The duration of treatment varied between 3 to 22 months; the median was 9 months (IQR 6–13 months). Patients with 3-month progression were excluded from the investigation. A complete and partial responses were recorded in 5 (3.4 %) and 19 (13.1 %) patients, respectively; the tumor process was stabilized in 118 (81.4 %) patients. The median duration of response to therapy with a combination of bevacizumab and IFN-α was 7 months (IQR 5–10 months). The progression-free survival was significantly influenced by prognostic factors, such as hemoglobin and neutrophil levels, age, and time from the diagnosis to starting therapy (p < 0.05). A history of nephrectomy had a significant impact on overall survival (p < 0.05).Conclusion. Our findings suggest that a history of nephrectomy and elevated neutrophil and alkaline phosphatase levels affect the efficiency of performed treatment in terms of an objective response to therapy. The factors influencing progression-free survival included the levels of hemoglobin and neutrophils, age, and time to diagnosis to start therapy.

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

Prostate cancer (PC) is a topical problem of oncourology because of the steady rise in morbidity worldwide. Despite the introduction of a diagnostic technique using prostate-specific antigen, the detection rate of the disease in its late stages remains high. Hormone therapy (HT) is considered to be a basic treatment in patients with metastatic PC. At the same time continuous HT is associated with the risk of developing side effects and can lower quality of life in the patients. Intermittent HT makes it possible to substantially reduce the cost of the performed therapy and to improve quality of life, without decreasing the efficiency of HT. The paper presents a review of clinical trials demonstrating the efficiency of intermittent HT, including the use of luteinizing hormone-releasing hormone analogues, in patients with PC.

Prostate cancer (PC) is one of the most burning problems of modern urologic oncology, which is attributable to the fact that the incidence of this pathology remains high. Hormone therapy (HT) is a basic treatment in patients with metastatic PC. Intermittent HT (IHT) is an effective and safe method for hormonal exposure in PC patients, as supported by the results of many trials. IHT may be recommended in the therapy of patients with PC in different clinical situations, including in patients with distant metastases. Eligard is recognized to be an effective and safe medicament to treat this category of patients. Its injection formulation once three or six months is easy-to-use for IHT.

Prostate cancer (PC) is one of the most burning problems of modern urologic oncology because the incidence of this pathology remains high now. Castration-refractory PC (CRPC) is an extremely heterogeneous disease whose prognosis is largely determined by a number of factors, including the number and site of distant metastases. In the patients with CRPC, distant metastases are verified with the highest frequency in the bones, lymph nodes, and lung. Atypical metastatic involvement cases are rarely observed in patients with CRPC. The paper gives a review of literature and describes a clinical case of the atypical site of metastasis in a patient with CRPC.