Cancer Urology

Background. Advancements in digital technologies have revolutionized surgical education. One such innovation is the remote mentor technology, which enables experienced surgeons to assist less experienced colleagues in real time using mixed reality and telecommunication tools.

Aim. To develop a remote mentoring system and assess its usability during laparoscopic partial nephrectomy from both the trainee and the mentor perspectives.

Materials and methods. Ten laparoscopic partial nephrectomies were performed using augmented reality and the Remote Mentor system. After each surgery, both mentors and trainees completed structured questionnaires assessing the quality of audiovisual exchange, interface intuitiveness, and communication completeness. The system used Hololens II and cloud-based software. Data were analyzed using non-parametric tests and correlation analysis.

Results. The median age of trainees was 36.5 years; mentors – 60 years. All participants rated the system highly, with no negative responses recorded. Significant positive correlations were found between operator age/experience and satisfaction scores. The system demonstrated strong technical performance and high subjective efficacy.

Conclusion. The remote mentoring system presents a promising tool for expanding access to surgical training. It showed high user satisfaction and technical feasibility. However, further validation with larger randomized studies is necessary.

Aim: to assess Immune-related toxicity and safety of first-line immune checkpoint inhibitors-based therapy in metastatic renal cell carcinoma (mRCC) patients treated in real-world clinical practice.

Methods: the retrospective study included data of 194 patients ≥18 years, with verified mRCC, treated with upfront combined immunotherapy, IO-IO (nivolumab + ipilimumab, 94 (48.5 %) patients) or immune-targeted therapy, IO-TKI (100 (51.5 %) patients: pembrolizumab + axitinib (85 (43.8 %)) or lenvatinib (10 (5.2 %)), nivolumab + cabozantinib (5 (2.6 %)) from 07.07.2019 to 22.10.2024 at Moscow City Hospital named after S.S. Yudin. All immune-related adverse events (irAEs) and regimen modifications from IO-IO or IO-TKI start to the last follow-up or death were registered.

Results: median duration of the first-line therapy was 11.1 (1.0–5 5.9) months (for IO-IO – 7.0 (1.0–55.9) months, for IO-TKI – 13.9 (1.0–45.2) months; р = 0,026). Median follow-up was 28.4 (1–63) months. IrAEs developed in 70.6 %, achieved grade ≥3 in 32.9 %, and grade 5 – in 7 (3.6 %) cases. Multiple irAEs were noted in 53.6 % patients and were more common in the IO-IO comparing with IO-TKI group (63.8 % vs. 44.0 %; р = 0,044). Frequent toxicities (≥10 % cases) included endocrinopathy (30.9 %), liver (22.7 %), renal (20.1 %), and gastrointestinal irAEs (10.3 %). IO-IO was associated with higher risk of renal toxicity comparing with IO-TKI (35.1 % vs. 6.0 %; р <0.0001). Risk factors for severe irAEs development were baseline anemia (р = 0,031) and neutrophil-to-lymphocyte ratio ≥3 (р = 0,031).

Conclusion: real-world data confirmed results of randomized trials regarding with irAEs rate and spectrum but demonstrated higher severe and multiple irAEs frequency in mRCC patients treated with upfront immune checkpoint inhibitors-based therapy. IO-IO was associated with higher rate of multiple irAEs and immune-related renal toxicity comparing IO-TKI.

Background. Prostate cancer remains the leading malignancy among men. The status of patients initially diagnosed with a Gleason score of (3 + 3) 6 based on biopsy results is becoming increasingly questioned. Can ISUP 1 be considered “NOTcancer”? Various additional diagnostic methods can be the key not only to establishing a prostate cancer diagnosis, but also to predicting the grade of cancer differentiation at the pre-invasive stage.

Aim. To assess the correspondence between biopsy and postoperative Gleason scores in patients with Gleason 3 + 3, and to study the pathological characteristics of true ISUP 1.

Materials and methods. The study analysed data from 225 patients who underwent radical prostatectomy between 2018 and 2024. The average patient age was 65 ± 6 years, median prostate-specific antigen level was 8.7 ng/mL, and median prostate volume was 55 cm³. All patients initially had a biopsy Gleason score of 3 + 3. Histological examination of surgical specimens was performed in accordance with national clinical guidelines.

Results. In 54.22 % of patients, the postoperative Gleason score increased to ≥7. ISUP groups 4 and 5 were identified in 4.89 % of cases, and pattern “5” was found in 1.33 % of patients. In all true ISUP 1 cases (45.78 %), characteristic pathological features of cancer were identified.

Conclusion. True ISUP 1 has all the morphological characteristics of cancer. More than half of the patients with a biopsy Gleason score of 3 + 3 had a higher final Gleason score upon histological examination. This confirms the need to improve existing diagnostic and treatment approaches for this patient category.

Background. Biopsy is the standard for prostate cancer (PCa) diagnostics. The false negative rate of 12-core biopsy is about 30 %. To improve the quality of detection of clinically significant PCa (csPCa) (ISUP (International Society of Urological Pathology) score 2 or more) during repeat biopsy, it is possible to use targeted diagnostic methods, such as HistoScanning (HS), cognitive fusion biopsy, hardware fusion biopsy.

Aim. To compare targeted prostate biopsy methods: HS, cognitive fusion, hardware fusion biopsy for the diagnosis of csPCa during repeat biopsy in patients with negative primary biopsy result.

Materials and methods. A prospective comparative study was conducted. The study included 320 men with suspected PCa after negative primary biopsy. Median age was 68 years, PSA level was 9.1 ng/mL, prostate volume was 57 cm², PSA density was 0.15 ng/ml/cm². Patients were divided into three groups depending on repeat biopsy method: group 1 – HS, group 2 – cognitive fusion biopsy, group 3 – hardware fusion biopsy; the groups were comparable with each other.

Results. PCa was diagnosed after repeat biopsy using HS, cognitive fusion, hardware fusion biopsy in 25.4, 45.5, 44.2 % of cases, respectively; csPCa was diagnosed in 4.5, 22.2, 18.2 % of cases, respectively. In all groups, PCa and csPCa were most often diagnosed with lesions in both target and standard biopsies. The use of targeting in the HS group did not provide an advantage in diagnostics. In the hardware fusion biopsy group, in the absence of cancer in standard cores, csPCa was diagnosed more often in targeted biopsies, compared with the cognitive fusion technique (11.8 % versus 7.5 %). With both fusion biopsy techniques, more malignant forms of PCa were diagnosed in targeted biopsies, compared with standard cores, however, due to standard cores, 23.5 % of PCa cases were not missed, of which 3.75 % were csPCa. The use of transrectal cognitive fusion technique showed a comparable result with perineal hardware fusion biopsy for diagnosing transition zone cancer.

Conclusion. The HS technique did not show advantages in diagnosing PCa during repeat biopsy. The use of cognitive fusion and hardware fusion techniques allows to improve diagnostics of both PCa and csPCa during repeat biopsy. According to our data, it is recommended to use targeted cores in addition to the standard ones. The use of cognitive fusion biopsy showed comparable results with hardware fusion in diagnostics of transition zone prostate cancer.

Introduction. Adverse event such as anemia and electrolyte imbalance are common in chemoradiation for bladder cancer.

Purpose of study. This study would like to identify potential predisposing factors, by conducting association and correlation analyses between age, severity, and social determinant with anemia and electrolyte imbalance in bladder cancer population with chemoradiation treatment plan.

Materials and methods. A prospective cohort study including consecutive bladder cancer patients treated with chemoradiation was conducted in a tertiary referral hospital in Medan between year 2022–2023. Bivariate and multifactorial categorical analyses were done to evaluate the association between age, severity, and social determinant (household income and education) groups with occurrence of anemia, hyponatremia, and hypokalemia in chemoradiation. Correlation analyses were done between age, severity, and social determinant (household income and education) with the level of hemoglobin and electrolytes level the in anemia, hyponatremia, and hypokalemia patients.

Results. About 30 patients included with mean age of 66.8 ± 8.23 years old and 3:2 male-to-female ratio. Bivariate analysis showed statistically significant association between age with anemia and hyponatremia (odds ratio 6.9; 95 % confidence interval 1.9–52.5 and 20.8 95 % confidence interval 1.2–342.7). Multivariate analysis resulted in an adjusted odds ratio of 6 (1.1–31.9) and 7.4 (1.2–45). Correlation analysis of age and hemoglobin level in anemia patient showed significant moderate correlation coefficient (r) of –0.52 (p = 0.018), indicating that the higher the age, the lower hemoglobin level in anemia during chemoradiation, while household income and hemoglobin, sodium, and potassium level showed moderate-strong correlation coefficient (r) of 0.61, 0.52, and 0.69 respectively (p = 0.004, 0,04, and 0.018), indicating that the lower the household income, the lower the hemoglobin, sodium, and potassium level during chemoradiation. Furthermore, Education showed a moderate correlation (r = 0.52) and strong correlation (r = 0.63) with anemia hemoglobin level and hypokalemia potassium level, respectively.

Conclusion. Our study showed that age and social determinants are predisposing factors of anemia and electrolyte imbalance in chemoradiation for bladder cancer and have a linear correlation with the abnormal level of hemoglobin and electrolytes after treatment.

Background. Radical cystectomy (RC) with neoadjuvant chemotherapy (NACT) is the main treatment approach in muscle-invasive bladder cancer. Despite improvement in RC techniques and postoperative systemic therapy, the number of local recurrences and cases of systemic progression remains high. The search for predictors of treatment efficacy in muscle-invasive bladder cancer remains an important problem.

Aim. To analyze long-term oncological outcomes of RC in patient groups with and without cisplatin-based NACT.

Materials and methods. Oncological outcomes of treatment of 214 patients who underwent RC with various urinary diversions were retrospectively analyzed. NACT in the form of 4 cycles of cisplatin + gemcitabine was administered to 73 patients (group 1, treatment). Overall survival (OS) and progression-free survival (PFS) were calculated. Time to outcome (patient death, radiologically confirmed recurrence or progression) were calculated from the date of surgical intervention.

Results. All 214 patients underwent RC with extended lymph node dissection. In group 1, complete response (ypТ0) was observed in 21 (28.8 %) patients, partial response in 20 (27.4 %) patients; 32 (43.8 %) patients did not respond to therapy. Median OS in this group was not reached, 5-year OS was 62 %. In the control group (without NACT), median OS was 42 months (95 % confidence interval (CI)14.1–69.8; р = 0.027). Median PFS in group 1 was not reached, 5-year PFS was 64.2 % (р = 0.032); in the control group, median PFS was 53 months (95 % CI 26.2–79.8). Results of Cox regression show that lymphovascular invasion increases the risk of recurrence 3.64-fold (95 % confidence interval 1.3–10.2; р = 0.014). Additionally, metastases in 2 or more lymph nodes also significantly affect the risk of recurrence (hazard ratio for рN2 status 3.8; 95 % CI 2.1–6.9; р <0.001). Patients receiving NACT had significantly lower risk of recurrence (hazard ratio 0.541; 95 % CI 0.3–0.96; р = 0.037). The quality of histological response significantly affected PFS (hazard ratio for partial response 0.283; 95 % CI 0.08–1.0; р = 0.05, hazard ratio for complete response 0.087; 95 % CI 0.01–0.67; р = 0.019).

Conclusion. Predictors for patient survival after RC are Т stage, N status (metastases in 2 or more lymph nodes), lymphovascular invasion. NACT significantly increases OS and PFS. Completeness of histological response to NACT is the factor improving PFS after PC the most.

Bladder cancer occupies a significant place among all malignancies, accounting for approximately 3 % of all new cases of malignancy per year, with approximately 37 % of all bladder cancer cases being fatal (about 213,000 deaths annually). Despite advances in diagnosis and treatment, patients with muscle-invasive cancer remain at high risk for recurrence and metastases, especially delayed metastases that may occur years after completion of primary treatment. These delayed metastatic manifestations are often associated with poor prognosis and treatment difficulties. This article presents a clinical case of late progression of bladder cancer to the left pubic bone without regional metastases 12 years after combination treatment.

In 2023 in Russia, 26,385 new cases of kidney cancer were registered. At diagnosis, per various estimations, up to 30 % of patients have distant metastases of renal cell carcinoma. Surgical treatment is considered the method of choice in patients with renal cell carcinoma with solitary (<2) metastases of any location which can be resected simultaneously or sequentially with the primary tumor. Intrathoracic kidney is observed in less than 5 % of ectopic kidney cases. In literature, only individual cases of treatment of patients with diagnosed cancer of ectopic intrathoracic kidney with Bochdalek’s hernia are described.

The article presents a clinical observation of treatment of a patient with oligometastatic cancer of ectopic intrathoracic left kidney: radical surgical treatment with simultaneous reconstruction of diaphragmatic hernia and subsequent adjuvant therapy with PD-1 (programmed cell death 1 receptor) inhibitor.

This review examines literature data on the possible relationship between development of kidney cancer and long-term nephrolithiasis. Results of research on the epidemiology of the diseases in question are presented, key take-aways and conclusions of the specialists who study this problem are reflected, current state of the issues of kidney stones-associated carcinogenesis of malignant kidney lesions is shown.

Platinum-based cytotoxic chemotherapy is widely used in treatment of locally advanced and metastatic bladder cancer (BC) and is the therapy of choice in neoadjuvant treatment of muscle-invasive BC not only in the Russian Federation but worldwide. In the context of predicted significant increase in BC morbidity and mortality in the coming decades, the search for molecular and genetic markers and introduction of complex diagnostic models into clinical practice is relevant that allow for personalized approaches to patient treatment and prevention of BC in order to improve long-term treatment outcomes.

Molecular profiling of individual and tumor genomes allows for the identification of markers for assessing sensitivity to standard polychemotherapy regimens, as well as identifying targets for immune and targeted therapy of BC. A literature search conducted in international and domestic databases (NCBI (http://www.ncbi.nlm.nih.gov/), PubMed (https://pubmed.ncbi.nlm.nih.gov/), eLIBRARY.RU (https://www.elibrary.ru/), Google academy (https://scholar.google.ru/)) demonstrated that a wide range of molecular genetic changes are involved in the carcinogenesis of BC.

Based on a number of studies, it has been established that alterations in the ERBB2, FGFR3, PIK3CA, RB1, FANCC, DNAH, KDM6A, CDKN2A, MGAM2, RNF213, DDR (MLH1, MSH2/6, PMS1/2, BRCA1/2, CHEK1/2, PALB2, POLE, BLM, ATM, etc.) genes, as well as the expression levels of ERCC1, BRCA1, and CTR1 are associated with the sensitivity of BC to polychemotherapy. In turn, а number of molecular genetic markers are also associated with sensitivity to immunotherapy in BC, including PD-L1 expression, microsatellite instability, high tumor mutational load, APOBEC signatures, CDKN2A/CDKN2B deletions, PD-L1 promoter methylation, as well as alterations of the FGFR3, MDM2, and TP53 genes.

In addition, FGFR (fibroblast growth factor receptor) inhibitor – erdafitinib and conjugate of monoclonal antibodies with cytotoxic agents – enfortumab vedotin are recommended for the treatment of BC, having demonstrated their effectiveness in clinical trials.

Integration of molecular and genetic diagnostics into clinical oncological practice will improve the accuracy of patient stratification and optimize therapeutic decisions, reducing the risk of unjustified drug load and increasing the effectiveness of systemic treatment.

Population of the patients with prostate cancer N1M0 is heterogenous, and their treatment requires the use of risk-adapted approach.

In case of clinically positive lymph nodes (cN1):

• choice option: external beam radiation therapy (EBRT) with long-term adjuvant androgen deprivation therapy (ADT) (36 months) and abiraterone with prednisolone (24 months);
• alternative: radical prostatectomy (in case of 1–2 enlarged regional lymph nodes and ISUP (International Society of Urological Pathology) grade 1–3) with possible subsequent prescription of ADT with or without EBRT depending on the presence of risk factors;
• in case of short life expectancy: immediate ADT in combination with abiraterone acetate and prednisolone or delayed ADT (depending on the presence of symptoms and expected duration of survival).

In cases of histologically verified metastases in the regional lymph nodes (pN1):

• choice option: immediate constant lifetime adjuvant ADT;
• alternative if postoperative prostate-specific antigen level <0.1 ng/mL or <3 positive lymph nodes: dynamic observation;
• alternative in the presence of risk factors (category pT ≥T3b, Gleason score 9–10, R1) and ≥3 positive lymph nodes: adjuvant EBRT and ADT.

Development of the optimal risk-adapted approach requires well-planned randomized clinical trials with adequate stratification and endpoints using high-fidelity diagnostic techniques, modern EBRT methods and new antitumor drugs.