Abstract:

Introduction: the main indicator that determines the prognosis of cancer is the degree of prevalence of tumor process at the time of detection. In terms of the growth of primary morbidity among urological cancers, bladder cancer ranks third, and prostate cancer is second. Treatment of patients in advanced stages is palliative and aimed at improving the quality of life and increasing its duration.

Bleeding from the bladder or prostate in such cases is a life-threatening complication and one of the most common causes of death in advanced cancer.

Aim: was to evaluate the effectiveness of embolization of arteries of the bladder and prostate in cancer patients with bleeding from the lower urinary tract as a preparatory stage for the subsequent specialized therapy of the oncological process.

Materials and methods: from 2019 to August 2021, 38 embolizing interventions were performed in 36 patients with recurrent bleeding from the bladder with ineffective conservative hemostatic therapy. Of these, there were 30 men and 6 women. The average age was 63 ± 2,6 years. All patients at the prehospital stage were diagnosed with pelvic cancer with invasion of the bladder wall without the possibility of radical treatment. Particles with a size of 300-500 µm, embolization coils and fragmentated hemostatic sponge were used for embolization.

Results: immediate angiographic success in the form of stagnation of blood flow through the target arteries was achieved in 100% of operations. In most cases, the relief of macrohematuria was achieved at day 4 (average values of erythrocytes in urine are 3,66 in p/sp). 2 patients (5,6%) underwent a second endovascular intervention during hospitalization due to the many small afferents suppluying the bladder tumor from the a. pudenta interna. Bleeding stopped in these patients by the 8th day of hospital stay. The early postoperative period in 100% of patients was accompanied by mild postembolization syndrome, which was stopped by symptomatic therapy within 24 hours.

Conclusions: endovascular embolization in patients with oncopathology using the superselective technique has shown efficacy in stopping urological oncological bleeding, allows to achieve stable hemostasis in a short time and to continue specific treatment of cancer in patients of the 2nd clinical group.

References

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https://doi.org/10.1007/s00345-018-2604-0

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https://doi.org/10.18565/urology.2020.5.133-138

Abstract:

Background: the optimal method for radiological diagnosis of prostate cancer (PCa) in planning multifocal biopsy is multiparametric magnetic resonance imaging (mpMRI)

Aim: was to improve the diagnosis of clinically significant PCa (csPCa) in patients with a negative primary biopsy, proceeding from mpMRI findings analysis based on results of the repeated procedure (24 cores) with targeted sampling of suspicious lesions.

Materials and methods: 732 patients were examined, 714 of them had been included in data of analysis. Prostatic mpMRI found suspicious foci with PI-RADS 3-5 in 396/714 (55.5%) patients. Results: The detection of PCa with a Gleason score of >7, PI-RADS 4 and 5 accounted for 65.9% and 80.0%, respectively Diagnostic sensitivity of mpMRI with a PI-RADS >4 in the diagnosis of PCa in patients with suspicious foci (n=396) was 83.6%, specificity - 84.9%; in the whole of 714 patients it was 46.4% and 86.7%, with a Gleason score of >7 - 75.3% and 89.3%, respectively In 73/290 (25.2%) patients with PI-RADS 3-5, PCa was detected in a systematic rather than in targeted biopsy, 17/73 (23.3%) of them having Gleason score >7. In 70/318 (22.0%) patients with PI-RADS 1-2, PCa was detected in systematic biopsy, in 11/70 (15.7%) cases Gleason score being >7.

Conclusion: mpMRI diagnostic accuracy for csPCa in patients with negative primary biopsy making it possible to refrain from repeated biopsy in males with PI-RADS 1-3; if repeated biopsy is necessary, the systematic one may be recommended.

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Abstract:

The prostate cancer is one of the most widespread forms of malignant new growths at men. Brachytherapy I¹²⁵ is a modern, hi-tech, effective, rather safe and easily reproduced method of prostate cancer treatment. In the Russian Scientific Center of Roentgenoradiology implantation of microsources I¹²⁵ in patients with localized and widespread prostate cancer is carried out by since 2003. For the last period 689 implantations of sources I¹²⁵ were spent. The tumor-specific survival rate after brachytherapy significantly didn't differ from a tumor-specific survival rate after radical prostatectomy. Thus, brachytherapy is a hi-tech, modern method of treatment in patients with prostate cancer and quantity of undesirable postbeam effects is less than after radical prostatectomy.

References

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Abstract:

Purpose. Was to determine the possibilities of transrectal ultrasound research (TUR) in grayscale-mode with the use of ultrasound angiography in diagnostics of rectitis and in monitoring its treatment in patients with prostate cancet (PC) after radiation therapy.

Materials and methods. The research consists of 62 patients with verified localized prostatic cancer (T13N01M0), which have already obtained conformed radiation therapy (RT) as a radical strategy. To estimate expressive radiation reaction patients were underwent transrectal ultrasound research before, during and after (in 3, 6, 12 months) radiation therapy. During the experiment, using grayscale-mode, the thickness of rectum front wall, its structure and echogenicity, and prostata capsula propria (lat.) tracking were estimated in dynamics. Vascularization of rectum front wall and pararectal cellulose was also analyzed in dynamics. Results of transrectal ultrasound were compared with clinical symptoms during the whole period of supervision, and were registered on the basis of patient’s personal note during and after treatment.

Results. Based on patients complaints we have noticed development of radiation rectitis (radiation therapy after-effect) which can be registered as higher thickness of rectum front wall, changes in its structure, decreasement of echogenicity and increased vascularization. The major part of patients with these changes noticed that such symptoms were therapeutically eliminated during supervision. Such echo-graphic changes won’t appear in case of prostate cancer progression and it can be used as a differential diagnostics between radiation therapy after-effect and prostate cancer growth.

Conclusion. Transrectal ultrasound allows to visualize early radiation rectitis implications in patients with prostatic cancer during radiation theraphy, and can promote the necessary treatment correction and advanced symptomatic therapy. 

References

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Abstract:

The aim of the study was to demonstrate possibilities of magnetic resonance imaging (MRI) with contrast enhancement and calculation of «index of contrast agent accumulation» in diagnostics of prostate cancer. Accumulation of contrast agent in malignant and benign tissues were analyzed in comparison and in details. Efficiency of provided method of diagnosis and definition of pathologic process localization is proved.

Reference

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12.     ESUR prostate MR guidelines 2012 Jelle O. Barentsz & Jonathan Richenberg & Richard Clements & Peter Choyke & Sadhna Verma & Geert Villeirs & Olivier Rouviere & Vibeke Logager & Jurgen J. F^tere^ Engelbrecht M.R., Huisman H.J., Laheij R.J., et al. Discrimination of prostate cancer from normal peripheral zone and central gland tissue by using dynamic contrast enhanced MR imaging. Radiology. 2003; 229: 248-254 

Abstract:

Literature review is dedicated to the diagnosis of prostate cancer (PCa), namely the use of Fusion-technology, a technique which allows you to combine real-time data of magnetic resonance imaging (MRI) and transrectal ultrasound (TRUS), as well as to perform biopsy of the prostate, taking into consideration previously detected changes.

Review includes russian-language and foreign articles that discuss not only benefits, but also limit of the use of methods of prostate biopsy in verification of malignant pathology Review is based on data of main online resources: PubMed, Scientific Electronic Library (elibrary), SciVerse (ScienceDirect), Scopus.

During analysis of available literature, authors discuss the problem of prostate cancer diagnostics, difficulties encountered when using of traditional biopsy methods.

Review pays special attention to MRI/TRUS Fusion-navigation in diagnosis of prostate cancer as an alternative to other, more widely used in practice methods as for initial biopsy and for repeated manipulations

Conclusions: A key aspect of the application of MRI/TRUS Fusion-navigation is the ability to perform precisely targeted biopsy of suspicious sites by the presence of malignant changes ir prostate tissue, which increases the accuracy of diagnosis of tumors. Above described method of biopsy is extremely promising as part of specifying diagnostics of localized forms of prostate cancer. Methodics appeared informative in identifying clinically significant prostate cancer and accurate for localization of process, especially in front parts of the prostate, compared with 12 traditional points of biopsy At the same time, this manipulation, compared with traditional biopsy technique, requires advanced equipment and highly skilled personnel. 

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