Cancer Urology

Background. Prostate cancer is the most common malignant neoplasm among men and the second leading cause of cancer-related mortality. According to studies, lymph node metastases are detected in approximately 15 % of patients after radical prostatectomy combined with extended pelvic lymph node dissection. In line with the European Association of Urology guidelines, extended pelvic lymph node dissection should be performed in high-risk prostate cancer cases and in intermediate-risk patients where validated nomograms predict a significant likelihood of lymph node involvement.

Modern surgical practice emphasizes the development of high-precision intraoperative imaging techniques to enhance the efficacy of interventions. One such innovative method is near-infrared fluorescence imaging, which utilizes fluorophores – substances that emit light upon laser excitation. For example, indocyanine green (ICG) is used as a contrast agent for fluorescence-guided surgery, improving tissue structure identification and surgical precision.

Aim. To evaluate the feasibility of fluorescence diagnostics using ICG during robot-assisted radical prostatectomy with extended pelvic lymph node dissection.

Materials and methods. At the A. I. Evdokimov Moscow State University of Medicine and Dentistry’s Urology Clinic (based at the S. I. Spasokukotsky City Clinical Hospital, Moscow Healthcare Department), 12 patients diagnosed with prostate cancer were analyzed between 2022 and 2023. Inclusion criteria were localized prostate cancer with histologically confirmed adenocarcinoma (Gleason score ≥7 (3 + 4)) and preoperative risk of lymph node metastasis exceeding 5 % as per the A. Briganti et al. (2012) nomogram. All patients underwent robot-assisted radical prostatectomy and pelvic lymph node dissection. During surgery, intraprostatic injection of ICG solution was performed after prostate isolation, followed by fluorescence imaging of lymph nodes using the FireFly™ mode on the DaVinci Xi™ robotic system.

Results. Patients were divided into two groups: Group 1 (n = 6) included patients with MRI-suspected pelvic lymph node metastases, and Group 2 (n = 6) had no imaging abnormalities. Postoperative histology revealed lymph node metastases in 5/6 patients in Group 1. In one patient from Group 1, metastatic involvement was confined to a single sentinel lymph node, which was visualized using ICG. No metastases were detected in Group 2. The mean fluorescence visualization time for pelvic lymph nodes was 17 minutes. Sentinel lymph nodes were identified in 6/12 patients, with intraoperative frozen section analysis confirming metastatic spread into these nodes.

Conclusion. Intraoperative fluorescence diagnostics with ICG is a safe and practical method to improve surgical outcomes in prostate cancer treatment. ICG enhances the identification of key anatomical landmarks and pathological structures. Sentinel lymph node biopsy may reduce complications associated with extended pelvic lymph node dissection and improve staging by enabling targeted removal of metastatic lymph nodes beyond the standard pelvic lymph node dissection template.

Background. One of the main methods of treating patients with prostate cancer (PCa) is radiation therapy (RT). Improvement of oncological outcomes depends on dose escalation. Thus, development of new RT techniques with increasing dose to the tumor is an urgent task.

Aim. To improve efficacy of hormone-radiation therapy in patients with PCa.

Materials and methods. In the prospective phase I–II trial, an original hypofractionated RT technique was developed based on prophylactic irradiation to the pelvic lymph nodes and prostate with 2.2 Gy to 44 Gy (45.9 iGy) and to the prostate with single dose of 2.7 Gy to total dose (TD) of 71 Gy (76.9 iGy) with simultaneous escalation of the dose to the prostate tumor to TD of 109.9 iGy. In the framework of the method, the parameters of the bladder (Bladder D2cс EQD2₃ < 90 Gy) and rectum (Rectum D2cс EQD2₃ < 75 Gy) doses described in the EMBRACE II protocol for planning RT for cervical cancer were taken as a prototype of the dose loads of the bladder.

Results. Between November 2023 and May 2024, 24 patients with PCa were treated according to the original RT method with escalation of the dose to the prostate tumor to 90/100.6/109.9 iGy, which became the criterion for dividing patients into 3 groups. At the end of RT, grade I–II gastrointestinal toxicity was observed, which completely resolved 6 months after the end of RT. Grade I–II radiation cystitis developed in more than half of the patients. Six months after the end of RT, dysuric phenomena persisted in 10 (41.6 %) patients, in 7 (29.1 %) of whom they were noted before the start of RT and were associated with the presence of the prostate tumor; in 3 (12.5 %) patients, symptoms of grade I radiation cystitis were observed. Most patients with stage T3 PCa were prescribed TD of up to 109.9 iGy. Dosimetry plans for all patients with TDs up to 90 and 100.6 iGy were optimal. However, in 2 of 8 patients with TD up to 109.9 iGy, the dose loads on the bladder (Bladder D2cc EQD2₃) were exceeded due to tumor invasion into the seminal vesicle according to stage T3b PCa. The dosimetry plan for 1 patient also with stage T3b PCa and escalation to 109.9 iGy matched all dose restrictions for the bladder, which was associated with the small size of the tumor and its location in the area of the orifice of the seminal vesicle, in contrast to the two above-described cases where the tumor invaded the seminal vesicle.

Conclusion. Dose escalation to the intraprostatic lesions can potentially improve oncological outcomes. However, its use in patients with clinical stage T3b PCa is limited due to the effect of the size and location of the prostate tumor of this stage on the dose loads for healthy organs. The option of treatment intensification in this case should be considered within the framework of personalized approach.

Background. Late progression of renal cell carcinoma (RCC) after radical nephrectomy is not uncommon, but data on systemic therapy response are limited.

Aim. To analyze survival rates and responses to systemic therapy, and to identify prognostic factors in RCC patients with late progression after radical nephrectomy.

Materials and methods. A retrospective analysis of data of 161 patients treated at the Municipal Oncologic Hospital No. 62 in Moscow and the Municipal Oncologic Dispensary in Saint Petersburg between 2006 and 2022 was performed. Mean patient age was 63.3 years (40–77 years), 68.1 % were men, all patients had previously undergone radical nephrectomy. 77 % of patients had a favorable prognosis and 18 % had an intermediate prognosis according to IMDC (International Metastatic RCC Database Consortium). We analyzed clinical and morphological data of patients who received systemic therapy for RCC diagnosed more than 5 years after radical nephrectomy. Statistical analysis was performed using Statistica 10.0 software packages (StatSoft, USA) by constructing Kaplan–Meier curves and survival tables, building a mathematical model of survival.

Results and conclusion. Median overall survival (OS) in the overall patient cohort was 52.3 months (confidence interval (CI) 43.8–62.9), and 3-year and 5-year OS were 64 % (95 % CI 57–72) and 43 % (95 % CI 36–52). All patients received first-line targeted therapy: tyrosine kinase inhibitor therapy was administered to 159 (98.7 %) and mTOR inhibitor therapy to 2 (1.3 %) patients, respectively. Median duration of first-line therapy was 34.1 months; 124 (77 %) patients received second-line therapy.

Univariate analysis in patients with late RCC progression showed that histologic variant (p = 0.048) and degree of tumor differentiation (p = 0.005), number of metastases (p = 0.003), metastases to lymph nodes (p = 0.026) and performance of metastasectomy (p = 0.028) were additional factors independently affecting OS rates.

Multivariate analysis showed that histological variant (p = 0.048) and degree of tumor differentiation (p = 0.045), IMDC prognosis (p = 0.005), bone metastases (p = 0.039), brain metastases (p < 0.001) and metastasectomy (p = 0.001) were additional factors with an independent effect on OS in patients with late RCC progression.

Patients with late RCC progression have higher OS and treatment response rates with systemic therapy due to a number of favorable prognostic characteristics.

Aim. To evaluate the diagnostic prospects of determining urine survivin level for monitoring the course of the disease in patients with non-muscle invasive bladder cancer (NMIBC).

Materials and methods. In total, 66 urine samples from patients with NMIBC were analyzed. The survivin concentration in the urinary supernatant was determined by bioluminescent immunoassay. All patients with bladder cancer were examined and treated at the Krasnoyarsk Regional Clinical Oncological Dispensary named after A.I. Kryzhanovsky taking into account current clinical guidelines. The main clinical and morphological parameters were evaluated: histological variant of the tumor, invasion depth, differentiation grade, size and number of lesions in the bladder, and risk group for disease recurrence. As part of the follow-up, times to tumor recurrence, development of muscle-invasive cancer, and metastasis were determined. Statistical data processing was performed using Microsoft Excel software for Windows 10, StatTech v.4.11.2 (developed by Stattech LLC, Russia).

Results. Urine survivin level of NMIBC patients before transurethral resection directly correlates with the risk group for disease recurrence. Decrease in the degree of tumor differentiation (p < 0.001) and an increase in the size of the tumor (p = 0.021) increase concentration of the cancer marker. Survivin level of more than 10 pg/mL significantly reduces disease-free survival, and level of more than 50 pg/mL also reduces event-free survival and progression-free survival.

Conclusion. The survivin cancer marker allows stratification of patients per unfavorable prognostic factors, which can be used to determine patient treatment tactics and subsequent follow-up.

Background. Renovascular anatomy is characterized by complex morphological variations in relation to the number, origin level, length, diameter and topographic relationships of the vessels. Understanding of individual vascular anatomy during the planning of surgical intervention in the retroperitoneal space allows to decrease technical difficulty and achieve better perioperative results.

Aim. To study frequencies of renal vessel variant anatomies that can become intraoperative finds in patients with germ cell tumors of the retroperitoneal location due to incomplete preoperative examination creating technical difficulties during surgical treatment.

Materials and methods. At the first stage, comparison of a group of 407 patients with germ cell tumors with a control group (401 patients with other oncological diseases) by the presence of vascular anomalies was performed. The second stage consisted of intragroup analysis of operative time, blood loss volume and complications in patients after retroperitoneal lymph node dissection depending on the identified vascular anomaly.

Results. Anomalies of renal arteries were identified in 73.2 % of cases in the germ cell tumor group which significantly differed from the control group value of 24.9 % (р = 0.001). The frequency of renal vein anomalies in germ cell tumors was 69.0 % compared to 12.5 % in the control group (р < 0.05). Median operative time in the total group was 217.2 ± 0.7 min. Statistically significant differences in increase of operative time in the presence of additional arteries (р = 0.001) and veins (р = 0.002) were observed. Total mean blood loss volume was 389 ± 51.4 mL. Intraoperative blood loss volume significantly depended on injury of additional arteries (р = 0.003) and veins (р = 0.002). Intraoperative complications associated with injury of the main large vessels were observed in 18.7 % of cases. Clinically significand trend was observed towards decreased intraoperative injury of additional and main vessels (total number of injuries 36 (8.9 %) and 76 (18.7 %), respectively; р = 0.017) and, therefore, decreased risk of surgical complications after accumulation of experience in retroperitoneal lymph node dissection and introduction of computed tomography with 3D reconstruction of renal vessels in 2018.

Conclusion. Frequency and diversity of various vessels of the retroperitoneal space in patients with germ cell tumors require careful preoperative preparation of the patients in the form of topographic visualization of the vascular network.

Low-grade oncocytic renal tumor is an extremely rare and new type of neoplasm. Its distinctive feature is a combination of benign and malignant signs, and the first description of the morphological species dates back to 2019. Since this period, 75 cases have been analyzed in 9 publications, one of which is domestic. Systematic reviews and randomized clinical trials are lacking. Currently, there are no recommendations, protocols for the management and treatment of patients with this rare pathology due to the small amount of data. The article presents a clinical observation of the diagnosis and treatment of a patient with a low-grade oncocytic tumor of the kidney.

Renal cell carcinoma (RCC) remains one of the leading oncological pathologies. A feature of the epidemiology of RCC is its predominant prevalence both in the morbidity structure of the elderly (60 years and older) (3.7 %) and in the young age group of 30–59 years (4.5 %).

In the present rare clinical observation of a patient with a late recurrence of RCC 10 years after nephrectomy, salvage surgical treatment (metastasectomy), rapid progression on first-line sunitinib targeted therapy and subsequent long-term durable tumor response to targeted therapy with multikinase inhibitor cabozantinib.

In this observation of a patient with multifocal visceral metastases in the 2^nd line, stabilization of disease was achieved during 4 years cabozantinib monotherapy, treatment continues to the present. Despite the extremely long continuous intake of cabozantinib at full dose and patient’s morbidity, no dose reduction or temporary breaks in therapy were required. Patient tolerates treatment satisfactorily with controlled adverse events – II grade drug-induced steatohepatitis with moderate cytolysis syndrome, I grade toxic dermatitis, I grade nause. Patient’s quality of life is preserved.

The presented work formulates the basic principles of a new concept of planning radiation therapy for prostate cancer which allows to achieve high functional and oncological treatment results. It is based on a temporary change in the mutual topography of the irradiated gland and adjacent normal tissues due to perineal implantation of a paraprostatic biodegradable spacer. Formation of an additional distance between the prostate and the rectum allows not only to significantly reduce the risks of post-radiation rectal toxicity but also ensures safe local escalation of the dose, as well as its optimal spatial distribution in relation to other critical organs. This approach was named tetrafecta radiation therapy.

Three-dimensional reconstruction and CT-based modelling are increasingly used for preoperative planning in renal tumour surgery. This narrative review summarizes 42 publications focused on virtual 3D models, 3D printing and holographic reconstruction to assess patient-specific anatomy, including renal vascular architecture and tumour relationships. The literature suggests that 3D models may improve anatomical understanding, influence surgical strategy, and potentially optimize selected perioperative outcomes (operative time, blood loss, ischemia parameters). The review also outlines areas where artificial intelligence methods may be applied (primarily automated segmentation and faster image post-processing) and discusses limitations of implementation (standardization, validation, organizational and legal issues).

Introduction. Kidney renal clear cell carcinoma (KIRC) is the most common subtype of kidney cancer, making up about 70–80 % of all cases. This cancer displays high molecular heterogeneity and responds poorly to standard therapies. Over the past decade, research on KIRC has shifted significantly toward genetically based treatments and precision medicine.

Aim. To analyze global trends in KIRC genetics and treatment research through a bibliometric review of the Scopus database from 2009 to 2025.

Materials and methods. The method involved collecting documents with the keyword “Kidney Renal Clear Cell Carcinoma” in English. The data were analyzed using VOSviewer software for keyword network visualization and Bibliometrix (R Studio) for descriptive analysis, including publication growth, international collaborations, affiliations, and citations. Analysis was also conducted on thematic clustering and the identification of the most influential authors and institutions.

Results. There were 870 publications across 285 sources, with an annual growth rate of 28.31 %. International collaborations made up only 9.66 %, highlighting the dominance of domestic partnerships. The most active author was Wang Y, with 58 publications and 773 citations. Three main thematic groups were identified: gene-based prognostic models, pan-cancer approaches, and molecular mechanisms of tumors. Topics like immunotherapy, multi-omics, and artificial intelligence experienced notable increases in citations.

Conclusion. KIRC global research advanced quickly toward integrating genetically based precision therapies. This study provided a strategic foundation for research planning, funding, and international collaboration in molecular oncology.

Expansion of therapeutic options for progressive prostate cancer, particularly the use of second-generation androgen receptor inhibitors (SGARIs) in earlier therapy lines, has led to a significant increase in patient survival. The longer time to progression and, consequently, the higher number of treatment lines involving this pharmacological class in an elderly patient population with high prevalence of comorbidity and polypharmacy creates a substantial risk of adverse drug-drug interactions.

This review examines the pharmacokinetic and pharmacogenetic characteristics of modern SGARIs: apalutamide, enzalutamide, and darolutamide, as well as the mechanisms of their drug-drug interactions at the level of cytochrome P450 isoenzymes and transporter proteins. Particular attention is paid to clinically significant interactions with anticoagulants, antiarrhythmic agents, lipid-lowering drugs, and glucose-lowering medications.

It is demonstrated that therapy with enzalutamide (a strong inducer of CYP3A4, CYP2C9, and CYP2C19) and apalutamide (an inducer of CYP3A4 and CYP2C9) can reduce systemic exposure of a wide range of concomitant medications, including drugs used to treat cardiovascular diseases, diabetes mellitus, and anticoagulants. This may lead to loss of their clinical efficacy and is associated with a high risk of clinically significant drug-drug interactions. Darolutamide, which is neither an inducer nor an inhibitor of key cytochrome P450 isoenzymes, demonstrates minimal potential for pharmacokinetic interactions and is characterized by a more predictable safety profile in patients with polypharmacy.

Assessment of the comorbidity burden and the risk of drug-drug interactions is a critically important element during selection of therapy based on SGARIs. For patients with prostate cancer receiving multiple concomitant medications, especially those with a narrow therapeutic window (anticoagulants, antiarrhythmics, anticonvulsants), darolutamide may be the preferred choice due to its low potential for drug interactions.