[Chemotherapy of hormone-resistent cancer of the prostate].

A total of 59 patients with hormone-resistent prostatic cancer (HDPC) treated in 1999-2004 entered the trial. Three schemes of first-line chemotherapy were examined for clinical efficacy and toxicity in the above patients. Anticancer combined treatment vinorelbin + cycloplatam was given to 23 patients, mitoxantron + prednisolone--to 23 patients, mitoxantron+cysplatin+prednisolone--to 13 patients. The latter scheme was most effect and toxic. Partial regression of metastases and a 50% decrease in the initial PCA level were seen in 23% cases. Vinorelbin+cycloplatam was less effective and toxic: partial regression of metastases--13%, PSA regression-- 17.4%. The least efficacy and toxicity were observed in the treatment with mitoxantron+prednisolone --.7%. Thus, the above first-line HDPC therapy was most effective but has the highest toxicity in using the scheme mitoxantron+cysplatin+prednisolone.

[The role of preserving therapy of invasive cancer of the urinary bladder].

Cystectomy in the treatment of invasive cancer of the urinary bladder is not the only therapeutic modality in this pathology. In selected patients an alternative exists--transurethral resection of the urinary bladder followed by adjuvant concurrent chemotherapy and radiotherapy. The preserving therapy can be recommended to patients over 60 years of age in the presence of a low-grade solitary tumor of a mobile wall of the urinary bladder respectable with preservation of the organ capacity.

[Regional metastases of penile cancer: optimal treatment policy]. / Regionarnye metastazy raka polovogo chlena - optimal'naia taktika lecheniia.

Emergence of regional penile cancer (PC) metastases reduces late survival of PC patients from 94.4 to 83.9%. PC stage can hardly be diagnosed by clinical data significantly. Bilateral inguinal lymphadenectomy is indicated for all PC patients with enlarged and clinically negative regional lymph nodes in poorly differentiated primary tumor (G3) and stages T2-3. Follow-up can be recommended for patients with stage Tis-T1, low and moderate anaplasia (G1-2) of the primary tumor. Metastases to the iliac lymph nodes are an indication to pelvic lymphadenectomy. Preventive removal of the iliac lymph nodes in intact inguinal ones is not justified. Unremovable fixed regional lymph nodes should be exposed to radiotherapy.

[Results of a 5-year screening for prostatic cancer]. / Itogi 5-letnego skrininga raka predstatel'noi zhelezy.

The results of 5-year screening (1996-2000) for prostatic cancer in 1129 males 40 to 80 years of age are presented. The examination included: measurement of blood levels of prostate-specific antigen (PSA), finger rectal examination, transrectal ultrasonic examination (TRUE) and, on demand, biopsy of the prostatic gland. Prostatic cancer was diagnosed in 1.5, 2.2 and 16% patients having PSA levels of 0-4.0, 4.0-10.0 and 10.0-30.0% ng/ml, respectively. At finger rectal examination prostatic cancer was suspected in 8% examinees, only in 33% of them the diagnosis was verified morphologically. By TRUE evidence 7% examinees were suspected and in 44.3% of them prostatic cancer was confirmed. Thus, biopsy proved necessary in 172 cases of 1129 examinees. In 64 (5.7%) males prostatic cancer was diagnosed and confirmed. Early prostatic cancer in the screened men and those consulted in the outpatient department of the National Cancer Research Center was detected in 77.7 and 22% men, respectively. The conclusion is made that men over 50 years of age should undergo prophylactic examination of the prostatic gland once a year.

[Is maximal androgenic blockade necessary in the treatment of prostatic cancer?]. / Nuzhna li maksimal'naia androgennaia blokada v lechenii raka predstatel'noi zhelezy?

As the literature data give arguments both pro and contra wide use of maximal androgenic block (MAB) in the treatment of prostatic cancer, the authors studied MAB in 200 patients. They came to the conclusion that MAB can be applied in patients with symptoms of disseminated prostatic cancer as neoadjuvant therapy before prostatectomy and as neoadjuvant and adjuvant therapy in planning radiotherapy.

[Results of organ-preserving therapy for invasive bladder cancer]. / Rezul'taty organosokhraniaiushchei terapii invazivnogo raka mochevogo puzyria.

87 patients with urinary bladder cancer (UBC) stage T2-3aN0M0 have received an organ-saving treatment which combined neoadjuvant chemotherapy (methotrexate, adriamycin, vinblastin, cysplatinum) followed by transurethral or open resection of the bladder. The patients were followed up for 3 to 60 months. Recurrent tumors arose in 49(56.3%) patients, at the primary site in 94%. Recurrence-free 5-year survival made up 32.8 +/- 14.1 and 24.2 +/- 15.2% after transurethral and open resections of the bladder, respectively. In patients with a complete response to the neoadjuvant chemotherapy 5-year overall and recurrence-free survival reached 89.0 +/- 11.1 and 68.5 +/- 18.9%, respectively. It is thought valid to consider planning organ-saving treatment only in relation to patients with a complete regression of the tumor after neoadjuvant chemotherapy.

[Liver resection in locally-spread and metastatic kidney cancer]. / Rezektsii pecheni pri mestno-rasprostranennom i metastaticheskom rake pochki.

The postoperative outcome and survival were studied in patients operated for renal cancer with involvement of the liver. 9 patients have undergone radical nephrectomy and 12 patients--hepatic resections for direct hepatic involvement (2), synchronous (2) and metachronous (8) metastases of renal cell carcinoma. Right hemihepatectomy was performed in 2 and wedge resection in 10 cases. A complete resection was performed in 8 of 9 patients while one patient with direct hepatic invasion was found to have positive surgical margins. Postoperative lethality was absent but complications occurred in 6 patients: pancreatitis (1), pneumonia (3), hepatic abscess (1), hepatic and renal failure followed by GI bleeding (1). At follow-up, two patients died of progressive disease 4 and 68 months after the surgery and one was lost for follow-up. One patient with positive surgical margins is alive with pulmonary and liver metastases 16 months after surgery. Five patients are alive with no evidence of relapse 6, 10, 12, 19 and 56 months after the operation. Thus, the aggressive surgical approach is justified and should be considered in patients with renal cancer and hepatic involvement.

[Role of fluorescent control in raising radicality of surgical treatment for superficial bladder cancer]. / Rol' fliuorestsentnogo kontrolia v povyshenii radikalizma operativnogo lecheniia poverkhnostnogo raka mochevogo puzyria.

Solution of 5-aminolevulinic acid (5-ALA) and D-Light unit (Karl Storz GmbH & Co) were used for fluorescent control over radicality of transurethral resection (TUR) of the urinary bladder. TUR with the fluorescent control was performed in 85 patients. The new procedure allowed to remove tumors undetectable at standard TUR in 46(54.1%) patients. Sensitivity and specificity of the method was 98.7 and 76.3%, respectively. 5-ALA-induced fluorescence used to control radicality of bladder TUR reduced the number of recurrences within 12 postoperative months 2-fold.

[Statistics of oncourologic diseases in Russia in 1996]. / Statistika onkourologicheskikh zabolevanii v Rossii v 1996 g.

The trends in male urinary and genital cancer morbidity and mortality are specified. Statistics on separate malignant urological diseases are provided. In 1996 the number of patients with cancer of male urinary and sex organs reached 31.700. A growth in morbidity was due rather to a higher risk to develop the disease than because of changes in the population age. Urological cancer reduces mean life span of Russian population by 2 months, and the patients' life terminates 10-19 years earlier. Financial losses due to deaths of urological cancer stand as high as 197 million roubles as estimated in 1990 prices.

[An analysis of preliminary results in screening for prostatic cancer]. / Analiz predvaritel'nykh rezul'tatov skrininga raka predstatel'noi zhelezy.

450 males aged over 50 years free of urological symptoms were screened for prostatic cancer using three techniques; finger rectal examination (FRE), transrectal ultrasound investigation (TUI), assay for prostatic specific antigen in the serum (SPSA). SPSA quantities under 4 ng/ml, 4-10 ng/ml, 10-20 ng/ml, over 20 ng/ml were registered in 206(45.8%), 135(30%), 69(15.4%) and 40(8.8%) patients, respectively. Detectability of prostatic cancer increases by 33,37.9, 45.5, 69.2% due to TUI, FRE, TUI + FRE, all the three methods, respectively. Prostatic biopsy was needed in 102 (22.7%) cases. From the 450 examinees, prostatic cancer was diagnosed in 25 (5.6%). SPSA was high in all of them, higher than 10 ng/ml in 92%. 20 (80%) of 25 patients with cancer had early stages of the disease (TI-2). The study is going on.

[Is neoadjuvant chemotherapy valid in invasive cancer of the bladder?]. / Tselesoobrazna li neoad"iuvantnaia khimioterapiia invazivnogo raka mochevogo puzyria?

The role of neoadjuvant chemotherapy for invasive transitional cell carcinoma (TCC) of the bladder is not determined yet. M-VAC and CMV regimens have a complete response rate of 10-47% with an overall response reaching 80%. In 16.7-35% of all the responders and 42.9-92% of the complete responders a functioning bladder can be preserved. The influence of neoadjuvant chemotherapy on long-term survival is questionable. Nevertheless, the authors conclude that neoadjuvant chemotherapy is feasible in patients with invasive TCC as it improves the results of following surgery and in some cases enables an organ sparing operation.

[Maximal androgen blockade in the treatment of patients with disseminated cancer of the prostate]. / Maksimal'naia androgennaia blokada v lechenii bol'nykh disseminirovannym rakom predstatel'noi zhelezy.

Up-to-date approaches to treatment of disseminated prostatic cancer are discussed, including the experience of the use of maximum androgen blockade in 120 patients. The procedure may be recommended to start hormonal therapy in such patients with.

[Leydig-cell tumors of the testis]. / Leidigo-kletochnye opukholi iaichka.

The authors review case histories of 23 patients with leydigomas selected from records on 134 patients with nongerminogenic testicular tumors. Malignancy occurred in 6 cases. Two cases with uni- and bilateral testicular involvement are reported. The course of leydigoma in children is described.

[The results of the surgical treatment of bladder cancer patients]. / Rezul'taty operativnogo lecheniia bol'nykh rakom mochevogo puzyria.

101 patients with cancer of the bladder were operated in the Moscow Cancer Research Center from 1990 to 1995. Cystectomy with varying urinary bypass was made in 49 patients. 52 patients were subjected to bladder resection. The former developed recurrences in 28.9%, the latter in 62% of the patients. Recurrences after the resections were primarily local. 5-year survival of transient-cell bladder carcinoma patients after cystectomy made up 68.2%, after the resection 80.7%. The authors hold that both operations are applicable, but they have specific indications.

[Cycloplatam in the treatment of patients with disseminated prostatic cancer]. / Tsikloplatam v lechenii bol'nykh rasprostranennym rakom predstatel'noi zhelezy.

A 22% response rate was achieved in clinical trials of Russian drug cycloplatam in disseminated and hormone-resistant cancer of the prostate. In 80% of cases the drug has improved quality of life of patients with prostatic cancer stage III and IV. Antitumor effect and low toxicity make cycloplatam applicable in combined therapy of prostatic cancer.