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Currently, the choice of tactics of treatment of the patient with prostate cancer (PCa) requires to take into account the degree of differentiation and stage of tumor, age of the patient and his somatic diseases, the risk of complications, as well as the patient's desire and physician's experience. Due to the progressive development of medical technology, interest in minimally invasive treatments for prostate cancer, such as cryoablation, interstitial brachytherapy and HIFU-therapy, has grown. Cryoablation of the prostate gland is a tissue ablation by local effects of very low temperatures and is minimally invasive, highly effective treatment for prostate cancer that can be used as the primary treatment, and in the case of tumor recurrence after radiotherapy. Focal cryoablation of the prostate allows to selectively destroy the known tumor with preservation of organ function and without reducing the quality of life of the patient. Focal therapy for prostate cancer is an alternative to radical treatment and active surveillance, occupying an intermediate position between them. Due to the lack of long-term results, focal cryoablation is an experimental type of treatment. First cryoablation of the prostate using modern equipment was carried out in Russia in March 2010, at the Department of Urology MSMSU. Since that time, we performed this procedure in 122 patients with prostate cancer; cryoablation was primary treatment in 110 patients and was used as salvage treatment in 12 patients. In most cases, the operation was performed under epidural or spinal anesthesia. According to the protocol, all the patients underwent 2 cycles of freezing and thawing under transrectal ultrasound guidance. A significant improvement of equipment for cryosurgery, the use of cryoneedles with smaller diameter, and the use of temperature sensors and catheters to warm the urethral mucosa have allowed to minimize the number of complications in comparison with other methods of treatment of prostate cancer and achieve a high disease-free survival. Our prospective study was aimed to analyze our own results cryoablation of the prostate gland.

The effectiveness of perineal biopsy for the detection of prostate cancer (PC) using an array for brachytherapy/cryotherapy was evaluated. It is shown that perineal saturation biopsy provides high detection rate of prostate cancer in patients with suspected cancer after negative transrectal biopsies, does not increase the detection of clinically insignificant cancer and incidence of complications, but requires a lot of time and cost.

In current practice of pharmacotherapy of prostatic adenoma alpha1-adrenoblockers are first-line drugs the efficacy and safety of which have been proved in many randomized studies. Because of the appearance of a large amount of generic analogues of tamsulozine on the market we studied the ability of tamsulozine analogues to bind with alpha-adrenoreceptors on rat and human prostate affected by adenoma. Significant differences on the receptor level of interaction were found. Omnik, compared to other generic analogues of tamsulozine, has the highest affinity to alpha1-adrenoreceptors.

Radical retropubic prostatectomy (RPPE) for local prostatic cancer was made in 226 patients. Neurovascular bundles were preserved on one or both sides in 68 (30%) of them. Sixty one (90%) of these patients filled in questionnaires. In 37 (61%) of them the bundles were preserved unilaterally, in 24 (39%)--bilaterally. Only 7 (19%) patients had 4-5 score erection after unilateral nerve-preserving RPPE, 16 (43%) had tumescence. 0 score tumescence was detected in 14 (38%) patients of this group. Thirteen (54%) patients after RPPE with bilateral preservation of the bundles had 4-5 score erection. 0 score erection was in 3 (12%) patients of this group. Comparison of the patients under and over 60 years of age has shown that younger patients' erectile function recovers more quickly: in unilateral nerve-preserving RPPE in 20 and 12%, respectively; in bilateral operation--in 47 and 39%, respectively. Thus, erectile function can be preserved in patients after RPPE in careful preoperative selection of the candidates and in conduction of surgery meeting all modern requirements.

The results of 526 transrectal prostatic biopsies are available. Mean age of the patients was 64.6 years, mean level of PSA--10.4 ng/ml, mean size of the prostate--56 cm3. Biopsy was made in visualization of the prostate in the sagittal projection (ultrasound devices Bruel & Kjaer 1846 and Kretz Voluson 730). Application of Bruel & Kjaer Medical 2102 Hawk provides visualization of the prostate during biopsy both in sagittal and cross projection. Double visualization significantly improved detectability of prostatic cancer in patients with PSA 4-10 ng/ml. In biopsy of the top and peripheral zone there was lengthening of prostatic tissue fragments, reduced fragmentation of the columns, less frequent blank shots of the biopsy gun. The data obtained supports the importance of isolated placement and marking of prostatic tissue fragments in biopsy and allow to recommend wide clinical use of ultrasonic facilities with biplanic sensors providing online sagittal and cross visualization of the prostate.

The aim of the study was to assess frequency of various complications of transrectal multifocal biopsy of the prostate (TMBP), to specify prophylactic measures against such complications. Primary TMBP under US guidance was made in 612 patients (mean age 65.8 years, mean level of PSA 12.6 ng/ml). TMBP complications include: hematuria (220 patients, 35.9%), hemospermia (166 patients, 27.1%), pain in the perineum and the rectum (189, 30.9%), acute prostatitis (21 patients, 3.4%), acute orchiepididymitis (7 patients, 1.1%), acute urine retention (9 patients, 1.5%), long-term rectal hemorrhage (13 patients, 2.1%), loss of consciousness during the biopsy (7 patients, 1.1%). The analysis of TMBP complications leads to the conclusion that adequate preparation of the patients and accurate conduction of the prostatic biopsy technique under US guidance make this invasive manipulation diagnostically effective and safe.

To compare diagnostic value of transrectal prostatic biopsy in obtaining samples of tissue from different sites in patients with various levels of prostate-specific antigen (PSA) and prostate size, we made primary transrectal biopsy of the prostate in 486 patients. The patients were divided into 7 groups by the number of punctures at biopsy (from 6 to 18). Among the patients with PSA under 20 ng/ml in the number of tissue biopsy samples 18, a rise in prostatic cancer detection rate (PCDR) was 16.6%. In PSA above 20 ng/ml, a statistically significant maximal rise in PCDR occurred in the increase of biopsy number from 6 to 12 (by 9.3%). The number of local cancer forms in patients with PSA < 20 ng/ml among all the detected cases rose from 70% (biopsy from 6 sites) to 92.3% (biopsy from 18 sites). Among the patients with PSA < 20 ng/ml and the size of the prostate > 50 sm3, a significant rise of PCDR increased from 20 to 33.3% in an increase of the puncture number from 6 to 12. In the group of patients with the same PSA level and prostate > 50 cm3 PCDR improves in biopsy from 14, 16 and 18 sites (from 12.1 to 27.7%, 28.5 to 33.3%, respectively). Standard biopsy is insufficient for adequate PCDR, it is necessary to obtain samples of tissue from a large number of sites with puncture of peripheral zone of the prostate. Transrectal biopsy of the prostate according to the extended method improves PCDR, primarily, in local cancer.