Objective: to assess safety, pathological response rate, and long-term oncologic outcomes of radical prostatectomy (RP) after neoadjuvant chemotherapy using docetaxel in prostate cancer (PCa) patients of high and very high risk groups. Materials and methods: 86 patients with high and very high risk PCa (PSA>20 ng/ml, Gleason score 8 and more, or clinical stage cT2c and more) were included, among them 46 received neoadjuvant (NCGT/RP group) treatment followed by RP and 40 patients received RP only. with a median follow-up of 11.4 years after RP. Neoadjuvant treatment included 3-weekly docetaxel (75 mg/m2 for up to 6 cycles) with concomitant degarelix (6 monthly injections). Results: NCGT cycle was started in 39 patients and completed in full dose and planned regimen in 34 (87.2%) patients. Toxicities were moderate. A statistically significant reduction of PSA>50% post-chemohormonal therapy was observed in all 39 cases. Among patients with completed neoadjuvant treatment RP was performed in 33 (97.1%) patients. Lower postoperative stage was noticed in 38.5% in NCGT/RP group compared with 2.7% in RP group. Similarly, positive surgical margin rate was higher in group without neoadjuvant therapy - 43.2% and 25.6% (RP group). Adjuvant or deferred treatment received 25 (67.6%) and 13 (39.4%) in RP and NCGT/RP group, respectively. Conclusion: The use of neoadjuvant chemohormonal therapy before the RP in selected regimen and dose represents a safe strategy resulting in benefit in early oncological results. Given the limitations of the study this concept should be evaluated in large prospective controlled studies.
Background: The development of new non-invasive markers for prostate cancer (PC) diagnosis, prognosis, and management is an important issue that needs to be addressed to decrease PC mortality. Small extracellular vesicles (SEVs) secreted by prostate gland or prostate cancer cells into the plasma are considered next-generation diagnostic tools because their chemical composition might reflect the PC development. The population of plasma vesicles is extremely heterogeneous. The study aimed to explore a new approach for prostate-derived SEV isolation followed by vesicular miRNA analysis. Methods: We used superparamagnetic particles functionalized by five types of DNA-aptamers binding the surface markers of prostate cells. Specificity of binding was assayed by AuNP-aptasensor. Prostate-derived SEVs were isolated from the plasma of 36 PC patients and 18 healthy donors and used for the assessment of twelve PC-associated miRNAs. The amplification ratio (amp-ratio) value was obtained for all pairs of miRNAs, and the diagnostic significance of these parameters was evaluated. Results: The multi-ligand binding approach doubled the efficiency of prostate-derived SEVs’ isolation and made it possible to purify a sufficient amount of vesicular RNA. The neighbor clusterization, using three pairs of microRNAs (miR-205/miR-375, miR-26b/miR375, and miR-20a/miR-375), allowed us to distinguish PC patients and donors with sensitivity—94%, specificity—76%, and accuracy—87%. Moreover, the amp-ratios of other miRNAs pairs reflected such parameters as plasma PSA level, prostate volume, and Gleason score of PC. Conclusions: Multi-ligand isolation of prostate-derived vesicles followed by vesicular miRNA analysis is a promising method for PC diagnosis and monitoring.
Introduction. Artificial intelligence (AI) refers to computing technologies that simulate human intellectual processes. The use of AI in the near future will contribute to the widespread introduction of telemedicine technologies into practice. Materials and methods. The authors analyzed publications in PubMed and in the Electronic Scientific Library for the keywords oncology , urology , cancer urology , artificial intelligence . In PubMed, out of 127 articles that met the queries, 32 publications were selected, in the Electronic Scientific Library 3 articles were selected. Results. In kidney cancer, CT texture analysis with support vector method (SVM) can be considered promising; in order to predict the recurrence of bladder cancer, machine learning algorithms (support vector method) are used to identify the recurrence of bladder cancer by detecting urine micro-RNA. In order to reduce unnecessary biopsies based on clinical characteristics, an artificial neural network has been developed to predict the presence of prostate cancer. Conclusion. Artificial intelligence methods are constantly evolving, the range of their application in the field of oncourology is expanding. In the near future, we are not talking about replacing traditional methods, but in addition to them, artificial intelligence can provide more information about the patient. For the widespread introduction of these methods, mechanisms for overseeing the safety and efficiency of artificial intelligence algorithms should be developed. More research is needed to clinically and statistically compare the results obtained with AI with those obtained using traditional methods.
Introduction. Approaches to the diagnosis and staging of localized and locally advanced high-risk prostate cancer (PCa-НR) continue to be actively researched and improved. Materials and methods. In order to understand some of the controversial and controversial issues regarding the diagnosis of PCа-НR, a survey was conducted, in which 250 specialists took part – oncourologists, urologists, andrologists, specializing in the treatment / observation of patients with prostate cancer (PCа). The survey was conducted within the urological information portal Uroweb.ru by filling out a questionnaire. Results. The results obtained indicate that the most significant differences were obtained in views on the role of positron emission tomography combined with computed tomography (PET/CT) in the primary diagnosis of non-metastatic PCа and the importance of local prevalence in determining the risk of progression, while the attitude to genetic testing, primary local staging and prognosis criteria after radical prostatectomy in the majority respondents were similar. Conclusions. Most Russian oncourologists specialists involved in the treatment of PCа do not recommend that patients with PCа-HR perform PET/CT with prostate specific membrane antigen (68Ga-PSMA) and do not prescribe geneticist consultation and genetic counseling for non-metastatic PCа. To assess the local prevalence of the process in prostate cancer, based on the results of MRI, digital rectal examination and the percentage of tumor tissue in the biopsy sample. Most specialists determine the prognosis of a patient after RP by summing up the pathomorphological (PSA + radiological diagnostics + the result of histological examination) and clinical (PSA + radiological diagnostics + biopsy) indicators, which quite correlates with the global data.
Bladder cancer is the fourth most common cancer worldwide and the eighth leading cause of cancer mortality in men. The advent of new systemic therapies, including PD-1 and PD-L1 inhibitors, and advances in biomarker development have revolutionized the treatment of this disease. The current guidelines of the National Comprehensive Cancer Network (NCCN) support the inclusion of some new therapies in clinical practice. Over the past decade, many approvals for immuno-therapeutic agents have been obtained. Since bladder cancer is characterized by a high frequency of mutations, there has been a widespread introduction of medicines from the group of immune checkpoint inhibitors. All studies from this review were presented at a recent meeting of the American Society of Clinical Oncology (ASCO) and published in reputable journals.
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