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Background. Currently, about 80 % of men with low-grade prostate cancer (per ISUP 1 (International Society of Urological Pathology)) have indications for radical treatment. Overdiagnosis of low-grade cancer is associated with the use of systematic biopsy methods (standard transrectal, saturation) under ultrasound control for diagnosis verification. To improve prostate cancer diagnosis, the European Association of Urology (2019) recommended multiparametric magnetic resonance imaging before biopsy, and in case of detection of a suspicious lesion magnetic resonance imaging (MRI)-targeted biopsy. In clinical practice, the most common method of MRI-targeted biopsy is multiparametric MRI ultrasound-guided (mpMRI/US) fusion biopsy. However, some studies show contradictory results in detection of prostate cancer using systematic and MRI-targeted biopsy techniques.Aim. To compare detection of clinically significant prostate cancer (ISUP ≥2) using mpMRI/US fusion, standard, and saturation biopsy.Materials and methods. The study included 96 patients. The following inclusion criteria were applied: prostate-specific antigen >2 ng/mL and/or detection of a suspicious lesion during digital rectal and/or transrectal ultrasound examination, and PI-RADS (Prostate Imaging Reporting and Data System) v.2.1 score ≥3. At the first stage, “unblinded” urologist performed a transperineal mpMRI/US fusion and saturation biopsies. At the second stage, “blinded” urologist performed standard transrectal biopsy. Clinically significant cancer was defined as ISUP ≥2.Results. Median age was 63 years, prostate volume – 47 cm3, prostate-specific antigen – 6.82 ng/mL. MpMRI/US fusion, standard, and saturation biopsies were comparable in regard to the rate of detection of clinically significant (29, 24, 28 %; p = 0.81) and clinically insignificant (25, 26, 35 %; p = 0.43) cancer. Overall prostate cancer detection rates were also similar: 54, 50, 63 %, respectively (p = 0.59). The percentages of positive cores in mpMRI/US fusion, standard, and saturation biopsies were 33, 10 and 13 %, respectively (p p = 0.7).Conclusion. Detection rates of clinically significant, clinically insignificant prostate cancer and overall detection rate are comparable between systematic biopsy techniques and mpMRI/US fusion biopsy.

The current prostate cancer screening program results in unnecessary biopsies in a quarter of patients, overdiagnosis of clinically insignificant prostate cancer (ISUP 1) and overtreatment. Intoducing multiparametric magnetic resonance imaging into routine practice before biopsy allows to decrease the number of biopsies, thereby reducing the burden on clinicians and increasing the likelihood of detecting clinically significant forms of prostate cancer (ISUP >2). The objective of this literature review is to compare targeted biopsy techniques and to determine their current role in the prostate cancer diagnosis.

Background. High intensity focused ultrasound (HIFU) is a method of delivering acoustic energy to a focal point, thus destroying it and causing coagulation necrosis. Repeating the fires, the whole needed volume of organ can be treated without damaging the adjacent tissue. Objective. To establish the clinical efficacy and safety of HIFU in the treatment of prostate cancer on the basis of the authors’ 3-year experience in applying this technique.Materials and methods. A total of 101 patients with biopsy-proven prostate cancer (and 2 more patients had only high-grade PIN) have been treated in our clinic using an Ablatherm® device. Seventy-one of them were enrolled in this study. They were followed from sixth months to three years at a regular interval, the follow-up included PSA measurement and control sextant biopsies.Results. The median PSA nadir 1.5Р3.0 months after treatment ranged from 0.10 (in the low-risk localized prostate cancer group) to 2.50 ng/mL (in patients with a disseminated process). Negative control biopsies were in 75—80% of patients with localized prostate cancer and in 64—75% of the patients with disseminated process. Of all the patients, 91% underwent transurethral resection of the prostate before HIFU treatment. Such combination improved the efficacy of HIFU and reduced the treatment-related morbidity significantly. Grades 2 and 3 stress incontinence was observed in 1.9 and 0.9% of the patients, respectively. No other severe complications were recorded. Erectile function was preserved in 69.94% of the patients.Conclusion. Our results demonstrated the efficacy and low-associated morbidity of HIFU. HIFU does not exclude other treatment options and is repeatable if needed. HIFU seems to be a valid alternative treatment for patients who are not suitable for radical surgery.

Background: In patients with autosomal dominant polycystic kidney disease (ADPKD) and end-stage kidney disease, bilateral nephrectomy (BN) is currently performed predominantly via the laparoscopic approach. We analysed the results of BN depending on the approach and preoperative and perioperative factors. Patients and Methods: This was a single-centre retrospective study carried out from April 2010 to March 2020, including a total of 142 patients presenting with ADPKD who were treated by BN. Of these, 108 patients meeting the inclusion criteria were selected to analyse the results. We compared therapeutic outcomes depending on the surgical approach (laparotomy or laparoscopy) and the type of the operation (emergent or elective). Results: Of the 108 eligible patients, 36 (group I) underwent laparoscopic BN and the remaining 72 patients (group II) were subjected to midline laparotomy. Sixty-nine patients underwent elective surgery and 39 endured emergent operations. The most frequent indications (87 patients, 80.6%) for surgical treatment were urinary tract infection and infected cysts. The median length of hospital stay for group I and group II patients amounted to 8 days (IQR: 7.5–9) and 12.5 days (IQR: 9–16.5), respectively (p < 0.001). However, comparing the patients operated on electively, the actual difference in the length of hospital stay was inconsiderable: median 8 days (IQR: 7–9) in group I and 9 days (IQR: 9–11.5) in group II. The median duration of the operation was significantly (p < 0.001) longer in group I amounting to 217.5 min (IQR: 197.5–305) than in group II equalling 115 min (IQR: 107.5–145). The frequency of postoperative complications, lethal outcomes, and blood loss volume did not statistically significantly differ depending on the surgical approach. Only patients operated on emergency underwent releparotomy due to intraoperative large bowel injury. Lethal outcomes (n = 18, 16.7%) after surgery were observed only in emergent patients. Sepsis prior to surgery, systemic inflammation response syndrome (SIRS) with the CRP level above 173 mg/mL, prolonged preoperative antibacterial therapy, and undiagnosed large bowel injury were associated with a lethal outcome after BN. Conclusion: The results of open and laparoscopic BN in elective surgery were comparable. Emergency operations for infected renal cysts and SIRS were associated with increased incidence of large bowel injury and lethal outcomes.

Background. Pelvic floor muscle exercises are used as a first-line treatment for urinary incontinence after radical prostatectomy. Their efficacy is still being investigated. The use of biofeedback when teaching pelvic floor muscle exercises to patients increases the effectiveness of therapy.Objective: to assess the efficacy of biofeedback-assisted pelvic floor muscle training in patients with urinary incontinence after laparoscopic and robot-assisted radical prostatectomy and to compare the results of teaching.Materials and methods. A total of 64 patients with urinary incontinence after nerve sparing prostatectomy underwent biofeedback-assisted pelvic floor muscle rehabilitation. Radical laparoscopic surgery was performed in 48 (75 %) patients, whereas robot-assisted surgery was performed in 16 (25 %) patients. The patients started their training 2 months postoperatively. We used two-channel electromyography with the Neurotrack ETS system (United Kingdom) to teach the patients isolated pelvic floor muscle contractions. After achieving a minimum activity of abdominal muscles during pelvic floor muscle contractions, the patients started exercises.Results. There was no significant difference in age between patients who underwent laparoscopic and robot-assisted radical prostatectomy (р = 0.79). Fifty-five patients (85.9%) acquired the skill of isolated pelvic floor muscle contractions and could perform training on their own. The remaining 9 patients (14.1 %) required regular support from healthcare professionals at an outpatient unit (1–2 biofeedback-assisted trainings per month). Thus, the type of surgery did not affect the process of training. The type of radical prostatectomy had no impact on the acquisition of the pelvic floor muscle contraction skill.Conclusion. The time for restoration of urinary continence by biofeedback-assisted pelvic floor muscle training did not vary between patients after laparoscopic and robot-assisted radical prostatectomy.

Prostate cancer (PrC) is one of the most common tumors diagnosed in men. The detection rate of localized PrC has been dramatically enhanced by screening and the development of visualization methods. There are currently several techniques for focal treatment available, among which the most interesting in our opinion is high-intensity focused ultrasound (HIFU). Currently, HIFU hemiablation of PrC is not an established treatment, although evidence of its effectiveness and safety is growing. We have been performing HIFU hemiablation since 2013 and here report our results to add to the evidence on the effectiveness of the technique. Between October 2013 and December 2016, we performed HIFU hemiablation of the prostate for a total of 35 patients with confirmed PrC stage p < 0.001). The pathological focus seen on MRI before the procedure in each case was absent after 3 months. Control biopsy after 12 months revealed residual cancer in the contralateral lobe in 4 patients. The findings obtained during follow-up and from control biopsies indicate that the treatment was highly efficacious with a low rate of nonserious postoperative complications. HIFU hemiablation proved to be a reliable therapeutic modality for localized PrC and was associated with a low rate of complications and comparable risk of recurrence. Despite the fact that this method of treatment is currently experimental, the results of this case series and other studies indicate its feasibility and safety.

Introduction. The shear wave ultrasound elastography is a recently developed ultrasound-based method in the clinical practice, which allows the qualitative visual and quantitative measurements of tissue stiffness. In the 2010 this technology of the shear wave was called Shear Wave Elastograhpy. Due to the front of the shear waves the qualitative and quantitative assessment of the tissue stiffness is possible. Objective is to examine the efficacy of the shear wave ultrasound elastography in the evaluation of the prevalence of the oncological disease in patients with the prostate cancer and to compare the obtained results with the routine method X-ray diagnostics. Materials and methods. From the april 2015 in the I.M. Sechenov First Moscow State Medical University Urology Clinic there were conducted 314 shear wave ultrasound elastography examinations of the prostate. The ultrasound system Aixplorer® by SuperSonic Imagine was used. This system provides information provided by B-mode and shear wave ultrasound elastography mode. The transrectal echograms were made in 6 dimensions, so called Q-boxes (3 demensions in the every lobe on the segments from the base to the apex, according to the biopsy zone). The unit of measurement was the mean value in the kilopaskals (kPa). All the patients were randomized into 3 groups. There were 146 men with the possible prostate cancer in the first group (prospective study), 120 men with the certain diagnosis of the prostate cancer in the second group (retrospective study) and 48 healthy men in the third group (control study). In all the patients of the first and the second groups the routine complete examination, including the prostate specific antigen (PSA) level examination, digital rectal examination (DRE), doppler transrectal ultrasonography (TRUS), histoscanning and ultrasound shear wave elastography (SWE), was conducted. In the 229 patients of the first and the second groups the prostatectomy with the morphological verification of postoperative material was made. In the 63 patients of the first and the second groups the contrast-enhanced magnetic resonance imaging (MRI) of the pelvic organs was made. In the health men’s group, besides the ultrasound shear wave elastography, only the routine diagnosis methods of the prostate cancer (PSA level, TRUS and DRE) were used. Results. According to the results of our study, the threshold values for the normal prostate tissue stiffness due to the ultrasound shear wave elastography were from 0 to 23 kPa, for the hyperplastic prostate – from 23.4 to 50 kPa, for the prostate cancer – from 50.5 kPa. The data analysis of the 212 patients with the verified prostate cancer showed the increase of the mean degree of tissue stiffness due to the clinical stage and tumor differentiation (Gleason scale total score). All the patients were divided into the subgroups with the certain correlation values. In patients with the Gleason scale total score < 7, the mean degree of tissue stiffness was 72 kPa (n = 63). In 57 patients with the Gleason scale total score 7, the mean degree of tissue stiffness was 69 kPa. In 48 patients with the Gleason scale total score from 8 to 10, the tissue stiffness was averagely 119 kPa. The locally advanced stage Т3–4 was determined in 44 examined patients. The tissue stiffness value correlated with the tumor differentiation rate: the index variations were from 120 to 295 kPa. On the results of this method analysis, its resistance was 90,8 % and specificity was 94,6 %. According to the comparative assessment with the other examination technics, the informative value of the ultrasound shear wave elastography is far above the DRE, the doppler TRUS and the histoscanning, but is lower than the contrast-enhanced magnetic resonance imaging. Conclusion. In view of the above, the ultrasound shear wave elastography is a very informative method of the prostate cancer detection and it has a high rate of the agreement of the results with the contrast-enhanced magnetic resonance imaging and is more specific than the histoscanning.

The new potentialities of 3D transrectal ultrasound study were realized in a HistoScanning diagnostic unit. It has been used at the R.M. Fronshtein Urology Clinic, Research Institute of Uronephrology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, since September 2011. A study of the sensitivity and specificity of the technique enrolled patients undergoing high-intensity focused ultrasound (HIFU) ablation of the prostate of for its (PC) in the period 1 to 7 years. Prostate biopsy study with subsequent histology was made to confirm the results of histoscanning. Statistical processing of the obtained data showed that the sensitivity and specificity of histoscanning were 96 −100 and 87.5 −100%, respectively. These results allow one to appreciate histoscanning as a highly sensitive technique that advantageously differs in its significance level and informative value from now routinely used methods. The study on the possibility of planning and monitoring patients after focal treatments for PC opens up great prospects in achieving a balance between the radicality of performed surgery and the maintenance of quality of life in patients.

In September 2011, the Research Institute of Uronephrology and Human Reproductive Health began to use an apparatus for the early diagnosis of prostate cancer. One hundred and fifty-six studies have been conducted by now. In the examinees, the level of prostate-specific antigen was estimated to be in the range of 1.09 to 209 ng/ml. The results of the studies confirm European data on the sensitivity and specificity of this procedure.