Background. A lot of techniques are utilized in order to improve functional results of partial nephrectomy. Many questions regarding this issue remain controversial.

Aim. To evaluate the influence of various techniques on the functional results of partial nephrectomy.

Materials and methods. The retrospective study included 904 patients with renal cell carcinoma who underwent open partial nephrectomy between 2010 and 2019. The functional results were assessed according to the trifecta and pentafecta criteria. The effect on the functional results of the following techniques was assessed: a) enucleation of the tumor; b) coagulation of the bed without suture; c) preventive seams; d) hemostatic suture of the parenchyma;

e) earlier removal of the clamp from the kidney vessels; f) use of intraoperative ultrasound; g) selective clamping of a branch of the renal artery. The effect of the studied characteristics on functional outcomes was assessed using univariate analysis by determining the odds ratio (OR) with 95 % confidence interval (CI). The difference was considered significant at the significance level of p <0.05.

Results. Two techniques significantly improved the likelihood of achieving the “trifecta”: enucleation (OR with 95 % CI 2.27 (1.36–3.81), p <0.001) and preventive sutures (OR with 95 % CI 1.97 (1.22–2.83), p <0.001). The univariate analysis showed a statistically significant increase in the probability of achieving the pentafecta for three techniques: enucleation (OR with 95 % CI 2.28 (1.33–3.82), p <0.001), preventive sutures (OR with 95 % CI 2.22 (1.27–3.61), p <0.001), and coagulation of the bed without sutures (OR with 95 % CI 2.24 (1.29–3.76), p <0.001). When considering all techniques, a significant increase in the frequency of achieving the trifecta (OR with 95 % CI 2.31 (1.41–3.28), p <0.001) and pentafecta (OR with 95 % CI 2.41 (1.45–3.77), p <0.001) was observed.

Conclusion. Tumor enucleation, preventive sutures and coagulation of the removed tumor bed without suturing allow, even when used as a single technique, to significantly improve the functional results of partial nephrectomy. Other technical maneuvers we evaluated also provide improved functional results when used in combination, thus creating a new concept of nephron-sparing surgery.

Aim. To determine the impact of metastasectomy on overall survival in patients with metastatic renal cell carcinoma and to identify prognostic factors for this cytoreductive intervention.

Materials and methods. We retrospectively analyzed the database of 226 patients who underwent metastasectomy at the Moscow City Oncological Hospital No. 62 and the City Clinical Oncological Dispensary (Saint Petersburg) between 2006 and 2022. Solitary and single metastases were detected in 103 (45.6 %), and multiple metastases – in 123 (54.5 %) patients. In patients with solitary and single metastases synchronous and metachronous metastases were detected in 20 (19.4 %) and 83 (80.6 %) patients, with multiple metastases – in 51 (41.5 %) and 72 (58.5 %) patients respectively. Complete metastasectomy was performed in 70 (68 %) patients with solitary, single metastases and in 36 (29.3 %) patients with multiple metastases. Patients with solitary and single metastases after complete metastasectomy did not receive systemic therapy until tumor progression. Before the start of drug therapy metastasectomy was performed in 63 (61.2 %) patients with solitary and single metastases, in case of multiple metastases in 17 (13.8 %) patients. Patients’ survival rates were evaluated using the Survival Analysis mathematical and statistical method with calculation of descriptive characteristics in the form of a life table and construction of Kaplan–Meier curves.

Results. The univariate analysis in patients with multiple and oligometastases of renal cancer revealed that IMDC (International Metastatic RCC Database Consortium) prognosis, tumor differentiation degree per Fuhrman, ECOG (Eastern Cooperative Oncology Group) status, complete metastasectomy and metastasectomy after the start of systemic therapy had negative impact on survival rates. Multivariate analysis in patients with oligometastases of renal cancer revealed that IMDC prognosis, type of metastases, brain metastases, complete metastasectomy and metastasectomy after the start of systemic therapy had negative impact on survival rates, while in patients with multiple RCC metastases only complete metastasectomy and metastasectomy after the start of systemic therapy had negative impact on survival rates.

Conclusion. Our data indicate that metastasectomy is an important component of multimodal treatment of metastatic renal cell carcinoma patients. To better define the indications for this cytoreductive surgery, further studies are needed to identify additional prognostic factors in metastatic renal cell carcinoma patients.

Objective: to re-evaluate the efficacy and safety of lenvatinib with pembrolizumab in unselected Russian renal cell carcinoma (RCC) patients, included in the phase IV study, in a median follow-up extended to 17.1 months. The primary end point was progression-free survival (PFS), secondary end points were overall survival (OS), objective response rate (ORR) and duration of response (DOR), disease control rate (DCR) and its duration, as well as safety.

Materials and methods. The study included medical data of 165 patients with verified advanced RCC who received lenvatinib with pembrolizumab in 36 centers of the Russian Federation from 05.02.2018 to 25.07.2024. The median age was 60 (20–76) years, the male to female ratio was 2.3:1. The majority of patients had Karnofsky performance status ³80 % (74.6 %), clear cell RCC (93.3 %) without sarcomatoid differentiation (93.3 %), metachronous metastases (50.9 %) localized in >1 organ (75.2 %), were nephrectomized (63.0 %) and did not receive antitumor therapy (91.0 %). At the time of lenvatinib with pembrolizumab therapy start 40 patients (24.2 %) were classified into International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) favorable prognostic group, 92 (55.8 %) in the intermediate prognostic group, and 33 (20.0 %) in the poor prognostic group. The median follow-up was 17.1 (1.5–72.9) months.

Results. The median PFS achieved 24.0 (18.7–29.3) months, 17-month PFS 60.5 %. The median OS was 48.9 (18.5– 79.2) months, 17-month OS – 76.1 %. Objective response was registered in 46.0 % of patients including 2.4 % complete responders; the DCR was 92.1 %. The median DOR was 16.6 (2.1–72.9) months, duration of disease control –

14.3 (2.1–72.9) months. Confirmed dynamics of change in the sum of tumor foci diameters was recorded in 152 patients, while the median change was –25 % (from –100 % to +29 %). Any decrease in the sum of tumor foci diameters occurred in 69.1 % of cases. The incidence of any adverse events (AE) was 78.2 %, severe AE – 24.2 %, and serious AE – 9.7 %. Immune-mediated AEs developed in 17.0 % of cases and AE grades 3–4 in 6.7 % of cases. Mortality from AEs was 1.2 %.

Conclusion. Compared with the registration study, in real-world clinical practice in patients with advanced RCC the lenvatinib with pembrolizumab provides a lower ORR with comparable PFS and OS rates and demonstrates a satisfactory safety profile.

Prostate cancer is a very important problem in modern urologic oncology. The reason for this is a steady increase of morbidity and mortality in Russia and worldwide. Surgical treatment and hormonal/radiation therapy combination are the golden standard of radical therapy in patients with local and locally advanced prostate cancer. Vast experience has been accumulated worldwide in radical prostatectomy using various types of access: open retropubic, perineal, laparoscopic, and robot-assisted. Many studies focused on finding advantages of using minimally invasive access for this surgery, but the results are quite contradictory.

The article presents a systematic review of literature data, evaluation of the effectiveness of each access in radical prostatectomy in patients with prostate cancer.

Aim. To evaluate the results of radical surgical treatment and radiotherapy in patients with non-metastatic prostate cancer at age ≥75 years.

Materials and methods. The retrospective study included data from 151 patients ≥75 years with verified non-metastatic prostate cancer who underwent radical prostatectomy (RP) or external beam radiotherapy (EBRT). Median age was 81.0 (75.0–97.0) years. Median Charlson comorbidity index was 7 (4–12). Median baseline prostate specific antigen (PSA) level was 11.0 (1.8–172.0) ng/mL. Prostatic adenocarcinoma was verified (ISUP grade 4–5 – 30 (19.9 %)) in all patients. сТ category was сТ3–4 in 37 (24.5 %), cN1 category was diagnosed in 10 (6.6 %) patients. The groups of unfavorable intermediate, high and very high risk included 93 (61.6 %) patients. Radical treatmentwas performed in all cases: RP in 38 (25.2 %), EBRT in 113 (74.8 %) patients (109 (72.2 %) men completed EBRT). Adjuvant treatment was administered in 8 (21.1 %) patients who underwent surgery. In the EBRT group neoadjuvant androgen-deprivation therapy (ADT) was administered in 74 (65.5 %), adjuvant ADT in 79 (70.0 %) cases. Treatment groups were matched by the main characteristics (р >0.05 for all) excluding lower baseline PSA in the RP group (р = 0.013). Median follow-up was 46.2 (1.5–234.2) months for all patients.

Results. RP complications were registered in 3 (7.8 %), EBRT complications – in 7 (6.2 %) patients. No serious or lethal adverse event was observed. Recurrences were diagnosed in 9 (23.7 %) patients after surgery and in 26 (23.9 %) of 109 patients who completed EBRT. In the total study population, 4-year recurrence-free, cancer-specific, overall, and cardiac-specific survival rates were 74.5; 96.3; 91.2 and 90.8 %, respectively. The only factor significantly decreasing overall survival was Charlson comorbidity index ³8 (р = 0.05). Significant decrease of recurrence-free survival was observed in the surgery group compared to the EBRT group (р = 0.032). It did not translate into decreased cancerspecific and overall survival (р >0.05 for all). There was no significant difference in cardiac-specific survival between the groups (р = 0.626). Significant unfavorable prognostic factors of recurrence-free survival in the EBRT group included сN1 category (р = 0.045), very high risk (р = 0.049), and EBRT dose.

Conclusion. RP and EBRT in elderly patients with non-metastatic prostate cancer receiving treatment in real clinical practice have acceptable safety profile and provide effectiveness comparable to the historical data on patients not sampled by age. The optimal candidates for radical treatment are men with Charlson comorbidity index <8.

Background. Among malignant tumors in men in Russia, prostate cancer is the most common comprising 17 %. Despite the high effectiveness of radiotherapy for prostate cancer in about 20 % of patients, radiation damage of the pelvic organs develops affecting bladder, rectum, and intrapelvic cellular tissue.

Aim. To evaluate early and late complications of high dose-rate brachytherapy.

Materials and methods. Literature review was performed, and our own results of treatment of 276 patients using high dose-rate brachytherapy as monotherapy with different fractionation regimens: 19 Gy per 1 fraction and 15 Gy per 2 fractions were analyzed.

Results. High dose-rate brachytherapy as monotherapy is associated with low complication rate. There were no statistically significant differences between singleand two-fraction regimens. Evaluation of complication severity per the RTOG (Radiation Therapy Oncology Group) classification did not show complication severity above grade III. Early complications were diagnosed in 1.1 %, late in 3.3 % of cases. Between the treatment and comparison groups, no statistically significant differences in the frequency of urinary system organ symptoms per the IPSS (International Prostate Symptom Score) questionnaire were registered. Mean score per the IPSS prior to treatment was 4.0 (3.0–6.0) in the treatment group and 4.0 (3.0–8.5) in the comparison group. Mean follow-up duration in the treatment group was 65.0 (60.0–70.0) months, in the comparison group – 55.0 (49.5–65.0) months. After the treatment, mean IPSS score was 5.0 (4.0–5.0) in the treatment group and 5.0 (3.0–7.0) in the comparison group.

Conclusion. High dose-rate brachytherapy as monotherapy and in combination with external beam therapy is a safe and effective treatment method in prostate cancer. Serious and late complications are rare, however toxic effects of severity grades I or II can develop. Careful patient selection for brachytherapy, therapy planning methods, as well as active management of early and late toxicity by a multidisciplinary team with knowledge and experience in treatment of side effects of radiotherapy can help optimize treatment with high dose-rate brachytherapy.

Prostate cancer (PCa) is the most common oncological disease in men in Russia. For a long time, long-term androgen deprivation therapy (ADT) decreasing native testosterone level has been the basis of PCa drug therapy. At the time of PCa diagnosis, 2/3 of men have various risk factors for cardiovascular diseases (CVDs) or established CVDs (one fourth of the patients have CVDs associated with atherosclerosis; 45 % have a diagnosis of arterial hypertension). ADT is associated with increased risk of CVD and cardiovascular complications (CVC) development. Patients with PCa die of 2 main causes: directly due to cancer or due to CVD. Previously, luteinizing hormone-releasing hormone (LHRH) antagonists were considered to have a better safety profile compared to LHRH agonists. Comparison of all LHRH agonists (leuprorelin, triptorelin, goserelin, buserelin) with LHRH antagonists in meta-analyses showed that the risk of serious CVCs during LHRH antagonist therapy was 43 % lower than during agonist therapy. However, comparison of leuprorelin with antagonists did not show a significant difference in CVC rate. Leuprorelin is a drug with the most favorable profile of cardiological safety among the ADT drugs and the most frequently used LHRH agonist in the world. Considering high risk of CVDs and CVCs in patients with PCa, along with treatment of the main disease, careful control and reduction of risks of CVD development from the moment of PCa diagnosis should be implemented, the patients must be informed on the necessity of healthy lifestyle, established CVDs should be treated with rational regimens of antihypertensive, hypolipidemic, and hypoglycemic drugs. Risk control and reduction, as well as CVD treatment, should be performed for the whole duration of ADT. The article proposes an algorithm of cardiometabolic risk stratification prior to ADT initiation and during ADT.

Background. Radiopharmaceutical therapy with ²²³Ra dichloride (Xofigo®) is an effective method of treatment of bone metastases in patients with metastatic castration-resistant prostate cancer. Increased number of radiopharmaceutical therapy procedures with ²²³Ra requires revision and update of the existing requirements to ensure radiation safety. Current problems in terms of radiation safety during radiopharmaceutical therapy are assessment of radiopharmaceutical excretion from a patient body and radionuclide activity in patient biological waste.

Aim. To estimate the activity of ²²³Ra excreted from a patient body at hospital (during the first hours after radiopharmaceutical administration) and activity concentration in the sewage water of the hospital during radiopharmaceutical therapy with ²²³Ra dichloride (Xofigo®).

Materials and methods. Eleven male patients with metastatic castration-resistant prostate cancer undergoing radiopharmaceutical therapy with ²²³Ra dichloride were included in the study. Each micturition from patients in four hours had been sampled, and the samples were prepared to measure activity of ²²³Ra in the urine. The urine sample residue was flushed down a dedicated patient toilet in the Department of Radionuclide Diagnosis and Therapy. Sewage water sampling was performed at three points (at three manholes) of the hospital. The ²²³Ra activity in urine and sewage water samples was measured using a gamma semiconductor spectrometer.

Results. All urine samples exceeded the threshold value of ²²³Ra activity concentration and were considered liquid radioactive waste. The activity concentration of ²²³Ra in the sewage water close to the Department of Radionuclide Diagnosis and Therapy building, and at the point where the sewage water from the building merged with the water from and the nearest building exceeded the threshold value. The activity concentration of ²²³Ra decreased with increasing sewage water flow in the sewage system, and in the output from the entire hospital the activity concentration in the sewage water samples was below the threshold value.

Conclusion. The results of this work show dilution of patient biological waste and reduction of ²²³Ra activity concentration in the sewage system of a large hospital, which suggest that patient biological waste after radiopharmaceutical therapy with ²²³Ra dichloride could be disposed directly into the sewage system and a differentiated approach to patient waste management after radiopharmaceutical therapy with ²²³Ra dichloride could be applied.

Background. Radical cystectomy remains the gold standard of bladder cancer treatment for both muscle invasive form and high-risk patients. However, despite the patients’ high quality of life after radical cystectomy, formation of ureteroileal anastomoses (UIA) is still associated with a number of serious complications at various times in the postoperative period.

Aim. To evaluate the effectiveness of an original technique of UIA formation in the context of development of postoperative complications.

Materials and methods. At the N.N. Petrov National Medical Research Center of Oncology between January 2012 and October 2023, 465 radical cystectomies with ileal conduit were performed. In retrospective analysis, patients were divided into two groups: group 1 (n = 285) with the conventional technique for forming UIA, group 2 (n = 180) with a modified technique. Clinical and demographic characteristics of the groups were compared using t-test and χ2-test. Multivariate logistic regression analysis was performed to determine the likelihood of complications associated with UIA.

Results. Both groups were matched by clinical and demographic characteristics. The overall rate of complications associated with UIA was slightly lower in group 2 than in the conventional technique group (15 % vs. 16 %; p <0.001). Late complications associated with UIA were observed significantly less in the modification group (2.7 % vs. 4.2 %; p <0.001), and in group 2 repeat surgical interventions were required significantly less often. In multivariate analysis, the modified technique group was significantly less likely to develop UIA-associated complications than the conventional technique group (odds ratio 0.123; 95 % confidence interval 0.06–0.22 vs. odds ratio 0.179; 95 % confidence interval 0.12–0.27; p <0.001).

Conclusion. The presented modified technique of UIA formation can be quite effective in reducing the risk of developing UIA-associated complications.

Aim. To evaluate the effect of prognostic factors on survival rates of patients with penile cancer and to identify groups of patients with favorable and unfavorable prognoses.

Materials and methods. Retrospective analysis of data of 197 patients with penile cancer who were treated at the Moscow City Oncological Hospital No. 62 and Clinical Oncological Dispensary (Omsk) between 1997 and 2023 was performed.

Results. Statistically significant prognostic factors affecting survival rates of patients with penile cancer according to univariate analysis (log-rank test with p <0.05) and multivariate Cox regression analysis are: clinical stage (I–IV), T stage (T1–T3), resection margin (R0–R1), N grade (N0–N3), lymphovascular invasion, extranodal extension of metastasis to the inguinal lymph nodes, necrosis of the primary tumor, iliac lymph node involvement. Factors without significant effect on survival are: morphological structure of the tumor (p = 0.73), radiation therapy of the primary tumor (p = 0.38), chemotherapy (p = 0.46).

Conclusion. Analysis of clinical and pathomorphological factors allowed to identify an unfavorable prognosis group in patients with penile cancer for a personalized approach to improve survival rates.

The article presents a clinical case of mantle cell lymphoma of the prostate in a 75-year-old man who was hospitalized in the Emergency Urological Department of the City Clinical Hospital No. 52 with gross hematuria through cystostomy tube. During examination the patient was found to have prostatomegaly (prostate volume 992 cm3), prostate-specific antigen level was 2.2 ng/mL. Immunohistochemical examination of prostate tissue after adenectomy indicates prostate damage due to mantle cell lymphoma.

Urothelial carcinoma is the 4^th most prevalent malignant tumor after prostate (or breast), lung and colorectal cancers. Urothelial carcinoma of the upper urinary tract is quite rare and accounts for 5–10 % of all cases of this type of cancer. Tumors of the renal pelvis are 2 times more common than tumors of the ureter. A clinical case of a 69-year-old patient diagnosed with urothelial carcinoma of the left renal pelvis T2N0M1, stage IV and metastases into the bladder, right renal pelvis is presented. On 08.06.2023, the patient underwent transurethral resection of the bladder tumor, ureteric orifice, nephroureterectomy on the left, retroperitoneal lymphadenectomy. Between 07.2023 and 10.2023, the patient received 6 cycles of chemotherapy according to the following scheme: gemcitabine 1000 mg/m² intravenously on the 1^st and 8^th days ++ carboplatin AUC 5 intravenously on the 1^st day. Since 11.2023, the patient in receiving maintenance therapy with avelumab.

Neoplasms of the solitary kidney account for <1–5 % of all tumors of the renal parenchyma. Nephron-sparing treatment is the treatment of choice in patients with a tumor of the solitary kidney. Oncological safety and maximum preservation of the kidney parenchyma are the main goals of nephron-sparing treatment. As part of a personalized approach, patients may be offered partial nephrectomy (open, robot-assisted, laparoscopic techniques), thermal ablation, stereotactic radiation therapy, and active surveillance.

Options for prescribing immuno-oncological drugs and tyrosine kinase inhibitors in the neoadjuvant setting followed by kidney resection are being studied. Sometimes nephron-sparing treatment is not possible and radical nephrectomy is required.

This review provides a comprehensive assessment of possible treatment options for solitary kidney tumors.

Currently, renal cell carcinoma is one of the most common malignant neoplasms, the main treatment method of which is surgery. However, surgical treatment in some cases may be accompanied by deterioration of renal function, which dictates the need to search for alternative treatment methods. This review examines the possibilities of a minimally invasive, radiosurgical procedure – transarterial embolization of the renal arteries in the treatment of renal cell carcinoma. Options for performing this procedure and indications for them are given, the results of using transarterial embolization of the renal arteries for renal cell carcinoma are analyzed, and possible complications are described. The advantages of the method are indicated. The need for further large-scale scientific research devoted to studying the effectiveness and safety of transarterial embolization of the renal artery for renal cell carcinoma is urgent.

The need to process large amounts of data has led to the creation of software that can improve and facilitate the work of medical staff. Decision support systems (DSS) are now used in many branches of medicine both at the outpatient and inpatient stages of medical care, helping clinicians to choose the tactics of treatment and management of each individual patient. These systems to a certain extent can improve treatment results and diagnostic process. The introduction of DSS in clinical practice has shown many advantages in reducing the frequency of misdiagnosis and, consequently, the risk of medical errors. At the same time, DSS can have a number of disadvantages. For example, physicians may view them as a threat to their “clinical autonomy”, and the implementation and subsequent maintenance of DSS can be quite costly. Artificial intelligence, which is increasingly being used not only for diagnosis, but also for treatment and prediction of outcomes in various diseases, should be considered as a prerequisite for the creation of DSS. Active development of artificial intelligence has been noted in almost all branches of medicine. A non-systematic review of the available literature published in the period between 2012 and 2022 has shown that the application of AI in prostate cancer diagnosis has great potential in clinical practice, as it helps both in the choice of treatment method and in planning the course of further surgery.