[Fusion biopsy of the prostate].

AIM: to compare the prostate cancer (PCa) detection rate, accuracy and safety of prostate image-guided fusion biopsy methods (cognitive fusion, software-fusion and HistoScanning-guided biopsy) on the basis of published studies in patients from 48 to 75 years with suspected prostate cancer during primary or repeat biopsy. To identify the limitations of these methods and improve the efficiency of fusion biopsy of the prostate in a further clinical trial. MATERIALS AND METHODS: search was carried out in the PubMed, Medline, Web of Science and eLibrary databases using following requests: (prostate cancer OR prostate adenocarcinoma) AND (MRI or magnetic resonance) AND (targeted biopsy); (prostate cancer OR prostate adenocarcinoma) AND (PHS OR Histoscanning) AND (targeted biopsy) and (prostate cancer OR prostate adenocarcinoma) AND (MRI or magnetic resonance) AND (targeted biopsy) AND (cognitive registration), targeted prostate biopsy, prostate histoscanning, histoscanning, cognitive prostate biopsy. RESULTS: a total of 672 publications were found, of which 25 original scientific papers were included in the analysis (n=4634). According to the results, PCa detection rate in patients with an average age of 62.5 years. (48-75) and an average PSA of 6.3 ng/ml (4.1-10.8), who underwent cognitive fusion biopsy under MRI control (MR-fusion) was 32.5%, compared to 30% and 35% for histoscanning in combination with a systematic biopsy and combination of methods (MR-fusion biopsy and histoscanning-guided biopsy), respectively. The accuracy of cognitive MR-fusion biopsy was 49.8% (20.8%-82%), the accuracy of the software MR-fusion biopsy was 52.5% (26.5%-69.7%), the accuracy of histoscanning-guided targeted biopsy was 46.8% (26%-75.8%). The highest values were observed in the patients undergoing primary biopsy (75.8%). DISCUSSION: Currently, imaging methods allow us to change the approach to the diagnosis of PCa by improving the efficiency of prostate biopsy, the only formal method for verifying PCa. A common method for PCa diagnosis in 2018 is a systematic prostate biopsy. However, due to the its drawbacks, fusion biopsy under control of MRI or ultrasound has being introduced into clinical practice with superior results. So far, there is a lack of sufficient scientific data to select a specific technique of the fusion biopsy of the prostate. According to the analysis, it was concluded that the incidence of complications didnt increase when performing targeted biopsy in addition to the systematic protocol. CONCLUSION: The efficiency of cognitive MR-fusion biopsy is comparable to software MR-fusion biopsy. Histoscanning-guided biopsy has lower diagnostic value than MR-guided target biopsy using software. The lack of solid conclusions in favor of a particular prostate fusion biopsy technique stresses on the relevance of further research on this topic.

[Vesicourethral anastomotic strictures and urinary incontinence following radical prostatectomy: relationship and impact on patients quality of life before and after endoscopic correction].

AIM: To assess the incidence and grade of concomitant stress urinary incontinence (SUI) and the quality of life before and after endoscopic correction of vesicourethral anastomotic strictures (VAS) and the impact of the number of endoscopic interventions on these indicators. MATERIALS AND METHODS: This is a retrospective study of medical records and a telephone survey of patients who underwent radical prostatectomy (RP) at our clinic from 2010 to 2015 and subsequently presented with VAS. The survey included data on the severity of SUI and quality of life using QoL questionnaire before and after endoscopic VAS correction; the factors primarily affecting the quality of life (SUI or obstructive symptoms) were identified. RESULTS: During the above period, 1453 RP were performed. There were 60 VAS cases, of which 56 (93%) were included in the study. Stress urinary incontinence after RP occurred in 64.3% of patients, the average QoL score was 3.95 ( = 0.64; Cv = 16.2%). Before endoscopic VAS correction, 87.5% of patients reported obstructive symptoms as the main cause of dissatisfaction. After endoscopic VAS correction, SUI was observed in 82.1% of patients. De novo incontinence occurred in 15 patients, higher SUI grade was observed in 29 (51.8%) patients. The observed change in the of SUI grade was not statistically significant (paired Students t-test 1.98, p> 0.05). Mean QoL score after endoscopic correction was 2.54 ( = 0.73; Cv = 28.6%, paired Students t-test 5.08, p <0.05). After endoscopic correction of VAS, 78.6% of the patients reported that SUI was the most important factor for decreased quality of life. CONCLUSIONS: The study revealed a high incidence of VAS combined with SIU. There was a significant improvement in patients quality of life after endoscopic correction of VAS, which resulted from a change in the pattern of voiding dysfunction producing a major negative impact on the quality of life. There were no statistically significant correlations between the number of endoscopic corrections of VAS and the SUI grade and the patients quality of life.

[Advanced microwave thermotherapy (PLFT) as a method of choice in the treatment of complicated, inoperable prostatic adenoma].

The aim of our study was assessment of efficacy of PLFT technique on ProstaLund CoreTHerm unit in nanagement of acute urine retention in patients with prostatic adenoma. We treated 31 patients with prostatic adenoma (age 58-97, mean age 74 years, volume of the prostatic gland from 32 to 188 ml); 11 patients had suprapubic fistula, 8 carried urethral catheter for acute urinary retention. All the patients were inoperable because of a high surgical-anasthetic risk. All of them were exposed to PLFT for 9-15 min. Efficacy of the treatment was assessed by recovery of physiological urination, by IPSS tests and quality of life (QoL). PLFT destroyed 15 +/- 5% prostatic tissue in each of the treated patients. The procedure was well tolerated. Physiological voiding was achieved in all the cases. Such complications typical for TUR as urethral stricture, vesical stenosis, urinary incontinence were not registered. On month 6 after the treatment QoL was assessed by the patients as 1-2 points, Qmax exceeded 15.2 +/- 1.9 ml/s. Thus, PLFT is a highly effective and save treatment of prostatic adenoma and can be recommended as a standard management of patients with acute urinary retention at high surgical risk.

[Prophylaxis of urine incontinence in prostatic cancer patients after radical prostatectomy].

We made a multivariate analysis of efficacy of different techniques of radical retropubic prostatectomy (RRP) for prevention of postoperative urine incontinence. A total of 226 patients operated (RRP) in the urological clinic of the Medical University from September 1998 to March 2004 were examined before and after the operation and followed up for 12-46 months. Complete urine retention in the postoperative period after removal of urethral catheter was achieved in 42% patients. By classification of F. Coakly (2002), complete urine retention 1 year after RRP (type 1) was registered in 189 (83.6%) patients. Urine incontinence (UI) of type 2 was observed in 18 (8%) patients, UI of type 3--in 8 (3.5%), of type 4--in 6 (2.7%) patients, total UI was in 5 (2.2%) patients. Earlier restoration of urine retention can be achieved if the surgeon uses careful isolation of apical urethra, saved puboperineal fibers m. levator ani, urinary bladder cervix, special technique of creation of the urethrovesical anastomosis. One year after RRP, 96% operated patients were satisfied with surgical outcomes. Thus, updating RRP technique radically improved treatment outcomes and, therefore, quality of life for patients with prostatic cancer. Nerve- and sphincter-saving, ablastic variant of this surgery is now widely applied in the world and is a method of choice for treatment of patients with prostatic cancer without extracapsular invasion.

[Preservation of erectile function in patients with prostatic cancer after radical prostatectomy].

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.

[Pinpointing the stage of prostate cancer after radical prostatectomy]. / Utochenie stadii raka predstatel'noi zhelezy posle radikal'noi prostatéktomii.

AIM: To analyse data of the preoperative examination of patients and histomorphological examination of prostatectomy samples to determine parameters allowing staging prostatic cancer (PC). MATERIAL AND METHODS: 27 patients with staged clinically diagnosed PC have undergone radical prostatectomy with histomorphological examination of the intraoperative samples of the prostate. RESULTS: The preoperative evaluation of PC has revealed no cases with Glisson's scale (GS) score under 5. Only 8.7% of the tumors were well differentiated, of them 28.3% had the score 7 and higher. 85% of the cases were moderately differentiated adenocarcinomas with the score 5 to 7. 33.3% patients had cancer diagnosed by prostatic biopsy (T1c). Nearly 48% had the tumor T2b, T2c. Histomorphologically, 50.7% of tumors were advanced. A high PSA level, a high score by Glisson and a clinical stage of the tumor at least T2b indicated high probability of extracapsular spread and of metastases to the lymph nodes each. The Glisson's score was higher at analysis of prostatectomy samples than prostatic biopsy in 10 (37%) cases while it was lower only in 2 (7.4%) cases. In 5 (18.5%) patients the difference made up 2 and more scores by Glisson. CONCLUSION: Thin needle biopsy examinations underestimate PC stage. To stage and predict the disease course precisely it is necessary to make a multifactor analysis.

[Screening for prostatic cancer]. / Skrining raka predstatel'noi zhelezy.

The discussion covers different aspects of application of programs of early prostatic cancer diagnosis. Arguments for and against the screening are presented. The existing methods of early prostatic cancer diagnosis are reviewed. How to improve the technique of taking prostatic biopsy is shown.