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Introduction. According to scientific studies, adenocarcinoma coincides with adenomatous tissue within the same prostate gland in 10–83.3 % of cases (including incidental cancer). Clinical situations in which the adenoma reaches a significant size (typically greater than 80 cm3 ) and thus creates considerable difficulties for surgeons occurs in not more than in 8–10 % of all cases of prostatectomy. Given the limitations of external beam radiotherapy and brachytherapy related with prostate volume and poor quality of urination, radical prostatectomy in this group of patients remains the treatment of choice. Features of adenoma, such as large median and lateral lobes, the presence of cystostomy and bladder stones, significantly complicate operational benefits. When an enlarged prostate is one of the factors prior to surgery, robotic technology may have certain advantages.The main goalof this work is to demonstrate the technical advantages of robot-assisted prostatectomy associated with enlarged prostate.Results and discussion. We describe the anatomical landmarks and possible surgical methods for overcoming different variations of benign hyperplasia of the prostate using robot-assisted prostatectomy. This information is particularly useful to surgeons aiming to master robotic surgical platforms. Robot-assisted prostatectomy can be effectively used in the treatment of prostate cancer associated with benign prostatic hyperplasia, and patients can have confidence in the results of such an operation.Conclusion. If a surgeon is sufficiently experienced, robot-assisted prostatectomy may become the method of choice in the treatment of patients with enlarged prostates.

Introduction. One of the biggest problems in the diagnosis of prostate cancer (PCa), which distinguishes it from many other solid tumour conditions, is the difficulty of detecting the tumour using standard imaging techniques. The primary method of diagnosis of PCa, which allows timely treatment, is prostate biopsy. However, under certain clinical situations a saturation biopsy allows a more accurate prediction of the volume and degree of malignancy of the tumour, which can be used to plan the tactics of treatment.Materials and methods. 81 patients were examined, whose mean age was 63.5 ± 7.4. The average volume of the prostate was 59 ± 24.2 cm3 , while the average level of the prostate-specific antigen was 12.5 ± 8.9 ng/ml. All patients underwent at least one transrectal prostate biopsy. The average duration of the transperineal saturation biopsy of the prostate was 25.2 ± 7.4 minutes. The average number of biopsies was 25.Results and discussion. Based on the results of transperineal saturation biopsy, prostate cancer was detected in 34 patients (43.2 %). Adenocarcinoma was detected in all patients with confirmed malignant pathology. Gleason grading was 6 points in 22 (27.1 %) patients, 7 in 9 (9.9 %) and 8 in 4 (4.9 %). Aggressive tumour types (Gleason 7 and 8) corresponded to PIRADS 4 and 5. In PIRADS 2 and 3, 80 % and 50 %, respectively, manifested prostatic adenoma without malignant manifestation. Following radical prostatectomy, the results of a planned morphological conclusion were studied alongside biopsy data. It was determined that in 80.0 % (n = 12) of cases the tumour did not go beyond the prostate capsule and in only 20.0 % (n = 3) of cases was not confined to the prostate. The coincidence of diagnosis based on biopsy results and morphological conclusion was 86.7 %.Conclusion. The study showed that saturation transperineal biopsy is often a reference diagnostic method when, despite the presence of clinical suspicion of PCa, a standard biopsy, including targeted fusion biopsies, fails to provide sufficient information to confirm or exclude PCa. In such situations, the proposed technique provides an alternative approach, with a good frequency of detection of prostate cancer.

Background. The presence of benign hyperplastic tissue does not exclude the malignant process within one prostate gland. According to various sources, almost 40 % of patients with prostate hyperplasia can be diagnosed of prostate cancer. The large adenoma seriously complicates of radical surgery, which in this group patients, is perhaps, the only effective method of treatment. The effect of prostate volume on the main criteria the effectiveness of treatment is ambiguous. Robotic technologies, introduced into clinical practice, may have the advantages of this complicated group of patients.Materials and methods. Study group (1st group): 40 patients with prostate volume ≥80cm3 (9.4 %) over the period December 2014. to December 2018. were performed robot-assisted radiсal prostatectomy. The comparison group included 54 patients with prostate volume <80 см3. The average prostate volume in 1st group was 112.2 ± 26 (80–195) cm3, in the 2nd group – 38 ± 11.2 (17–62) cm3 (p <0.001). The 1st group consists of older patients with a higher level of prostate-specific antigen (p <0.001).Results. The difference in the operation time was 18.2 min, which was statistically insignificant (p >0.05). The average volume of blood loss in the 1st group was 282.5 ± 227.5 (50–1000) ml, with 175 ± 147.2 (50–700 ml) ml in the 2nd group (р >0,02). After 12 months, 100 % of patients in the 1st group showed no relapse (prostate-specific antigen ≤0.2 ng/ml). The level of continental function was comparable of the monitoring group.Conclusion. When performing robot-assisted prostatectomy increased prostate size has no effect on operating time, but significantly increases of the blood loss. The size of the prostate may serve as an important variable to predict the functional and oncological results of treatment.