Marat Fayazovich Urmantsev

Purpose Creatinine-based eGFR equations may overestimate renal clearance in sarcopenic older adults, potentially leading to functional overdose of renally cleared antineoplastic agents. We quantified eGFR discordance by sarcopenia status and its association with early severe toxicity. Methods Retrospective multicentre cohort of 1,419 patients aged ≥ 65 years who received renally cleared antineoplastics across seven Russian centres (2018–2024) with staging CT within ± 30 days of cycle 1. Sarcopenia was defined by L3 SMI cut-offs (< 43 cm²/m² men, < 41 cm²/m² women). Discordance and functional overdose (CKD-EPI/proxy ratio > 1.15) were pre-specified. Primary outcome was CTCAE grade ≥ 3 toxicity in cycles 1–2. Mixed-effects logistic regression adjusted for ECOG, CCI, albumin, cancer type, stage, age and centre. Results Sarcopenia prevalence was 58.2%. Clinically meaningful discordance occurred in 48.7% and functional overdose in 72.2%. Grade ≥ 3 toxicity was 51.8% in sarcopenic versus 34.4% in non-sarcopenic patients and reached 59.1% when both sarcopenia and functional overdose were present. Adjusted odds ratios were 2.30 (95% CI 1.82–2.91) for sarcopenia and 2.49 (1.91–3.25) for functional overdose. Findings remained consistent in cystatin-C subset and after exclusion of carboplatin-treated patients. Conclusion Sarcopenia and functional overdose independently increase early severe toxicity risk. Equation disagreement should be treated as a prescribing-safety signal in older adults with cancer.

Prostate cancer ranks among the most prevalent malignancies in men, with disease progression driven by sustained androgen receptor (AR) signaling. Androgen deprivation therapy (ADT), which suppresses androgen synthesis and AR activation, serves as the standard treatment for advanced disease. ADT modalities include surgical castration, gonadotropin-releasing hormone agonists/antagonists, anti-androgens, and androgen synthesis inhibitors. Despite initial efficacy, long-term ADT is frequently complicated by the emergence of castration-resistant prostate cancer (CRPC) and multi-system toxicities involving metabolic, cardiovascular, and skeletal systems. CRPC arises from AR reactivation via gene amplification, mutation, splice variants and crosstalk with oncogenic pathways. Contemporary treatment intensification combines ADT with next-generation AR inhibitors, chemotherapy, and immunotherapy. Predictive biomarkers such as AR variant 7 and homeobox B13 facilitate patient stratification and individualized treatment decisions. The aim of this review is to summarize the role of ADT in prostate cancer management, with particular emphasis on androgen metabolism, AR signaling, mechanisms of castration resistance, ADT-related complications, and emerging therapeutic strategies. Based on systematic literature retrieval from PubMed and Embase (2018–2025), this review synthesizes current knowledge on androgen metabolism, AR signaling, CRPC mechanisms, ADT-related complications, and emerging therapeutic strategies to optimize long-term outcomes.

Secondary vagina atresia is a quite rare pathology, and due to its low incidence, the lack of standardized recommendations for the management of this group of patients, as well as the insufficient number of relevant randomized trials, the analysis of individual clinical cases is of special relevance. An analysis of the clinical case of a female patient with acquired vaginal atresia underwent surgical treatment – vaginal reconstruction with a Martius-Symmonds flap is presented. In dynamics, after the surgical intervention, good healing and autograft adaptation were noted, without necrosis and ulceration in the area of Martius-Symmonds flap transplantation, with neovagina sized up to 6.5 cm long and 3 to 4 cm wide in different localization. Due to the lack of standardized recommendations for management of patients with acquired vaginal atresia, it is necessary to continue examining and discussing such cases in clinical practice.

Background. Prostate cancer is the most common malignant disease in men. Obtaining high quality and diagnostically accurate tissue samples is paramount to the success of prostate cancer research. Collecting unfixed tissues from radical prostatectomy specimens for research purposes is challenging. Prostate cancer often cannot be detected on gross examination, and this tumor is known to be multifocal and heterogeneous making it of interest for interdisciplinary research.Aim. To develop a protocol that will improve the accuracy and quantity of biobanked primary prostate cancer tissue.Materials and methods. The removed unfixed prostate gland was dissected with a blade into two halves along the ureter, the tumor lesion was identified macroscopically, two sections were made: the first was separated into fragments and transferred into cryotubes and transport media for biobanking storage; the second was filled with gel, and frozen sectioning and histological verification of the tumor were performed.Results. Tumor was detected in frozen sections in 78.95 % (30/38) of cases. The mean time from organ removal from the abdominal cavity to macroscopic evaluation was 8–10 minutes, and the total time for histological verification was 30 minutes. The quality control performed on the biobanked material confirms that the developed protocol guarantees that both tumors and normal tissues are represented for further studies.Conclusion. This paper outlines a method for biobanking fresh prostate tissue removed during radical prostatectomy. The advantage of the method is the use of tissue samples both for diagnosis and for further study at the cellular and molecular levels.

Triple-negative breast cancer (TNBC) represents one of the most aggressive subtypes of breast cancer, characterized by the absence of key molecular targets including estrogen receptors (ER), progesterone receptors (PR), and HER2. This molecular profile significantly limits treatment modalities, establishing chemotherapy as the definitive treatment. The high rates of recurrences and metastasis, along with the lack of specific targeted therapies, make TNBC a major clinical challenge. This article evaluates critical prognostic and predictive biomarkers of TNBC, including BRCA1/BRCA2 gene mutations, PD-L1 expression, tumor-infiltrating lymphocytes (TILs), circulating tumor cells (CTCs), and circulating tumor DNA (ctDNA). These markers are pivotal for outcome prediction and treatment optimization. Moreover, a transformative approach to TNBC treatment is represented by personalized medicine based on molecular profiling supported by artificial intelligence (AI). The integration of artificial intelligence (AI) facilitates the analysis of substantial data sets, the accurate prediction of clinical outcomes, and the formulation of customized treatment strategies for individual patients. Thus, this article analyzes current data concerning prognostic and predictive markers of TNBC, with a particular emphasis on their clinical utility and the potential for personalized therapy.

Introduction. Prostate cancer (PCa) is one of the most common oncological diseases, the tactics of its treatment directly depends on the stage. According to statistics, prostate cancer (prostate cancer) accounts for more than 1.4 million new cases annually. The «gold» standard at the moment for localized prostate cancer is surgical intervention in the volume of radical robot-assisted prostatectomy. The aim was to development technologies for calculating the trajectory of movements of the traveled path of surgical instruments during robot-assisted radical prostatectomy; devalopment and implementation of an «active» robot system into the learning process, and later into the workflow; devalopment of a self-monitoring system for a surgeon in self-study. Materials and methods. On the basis of the Bashkir State Medical University clinic, 30 surgical robot-assisted radical prostatectomies performed by two surgeons were analyzed, of which surgeon 1 performed 14 surgical interventions and surgeon 2 performed 16 surgical interventions. Results. During the analysis, data were obtained on the average duration of the operation of robot-assisted radical prostatectomies, the movement time of robotic instruments. Conclusion. The study of the analysis of the time of movement of instruments is an important step towards optimizing resources and improving the efficiency of the medical process.

Introduction. Primary mature retroperitoneal dermoid cysts constitute a fairly rare pathology that is uncommon in men aged 50 years and older. In this article, we describe a case of a 68-year-old man with a large mature paravesical dermoid cyst extending into the rectovesical pouch and its successful surgical treatment using a da Vinci Xi robotic surgical system. Aim. To discuss the advantages of robotic access in the removal of large pelvic masses to achieve a speedy, successful outcome.Materials and methods. An oval-shaped mass in the right side of the lesser pelvis measuring 66×85×62 mm was detected during a pelvic MRI exam performed as a follow-up after an adenomectomy. The attempted ultrasoundguided puncture was unsuccessful. A diagnostic laparoscopy was indicated to collect biopsy samples of the mass, with its subsequent removal if possible. Histology results verified the presence of a retroperitoneal dermoid cyst. In order to ascertain its localization and relationship with surrounding tissues, as well as to determine the structural parameters, a PET CT scan was performed. The planned robot-assisted laparoscopic excision of the retroperitoneal pelvic mass was performed.Results and discussion. A general visual examination showed the removed specimen to be a cyst filled with a mushy mass of dirty white color, having an unpleasant odor and a large number of follicles. The histological study revealed an inflamed, ruptured retroperitoneal dermoid cyst.Conclusion. The clinical case shows that old age mature dermoid cysts are found in the elderly; however, with timely diagnosis, they can be fully treated.

Currently, robot-assisted radical prostatectomy (PARP) allows for achieving excellent oncological results with a low complication rate and is the “gold standard” for extirpative treatment of prostate cancer. Post-prostatectomy incontinence is the most devastating complication, significantly affecting the physical activity, and social and psychological well-being of men, and therefore has a significant impact on quality of life regardless of cancer outcomes and sexual function, which may have a potential impact on the choice of PARP as a treatment option. In a number of randomized and non-randomized clinical trials, the new techniques were compared with standard PARP, and their results were summarized in systematic reviews and meta-analyses. The aim of this overview was to compare the functional outcomes of various modifications of RARP in order to obtain reliable results and create a basis for clinical guidelines. Systematic reviews and meta-analyses were searched using the PubMed system in the electronic databases Medline, Embase, Cochrane Library, Web of Science, and Google Scholar until January 2024. Thus, this overview of meta-analyses fills an important gap in knowledge about the efficacy of new PARP techniques to guide clinical practice and future research and provide a basis for clinical guidelines.

Introduction. Robot-assisted radical prostatectomy is considered to be the “gold standard” for the radical treatment of prostate cancer, achieving excellent oncological outcomes with a low incidence of complications.Aim. To analyze and compare the efficiency of Da Vinci Xi and Da Vinci Si surgical systems applied in performing robot-assisted radical prostatectomy. Materials and methods. 165 patients were divided into two groups: Xi-group (n = 77) and Si-group (n = 88). The perioperative characteristics and oncological outcomes were analyzed and compared.Results. The demographic, clinical, and oncological characteristics of the two patient groups appeared similar and comparable. Interventions involving the preservation of the neurovascular bundle, the pelvic fascia, and the puboprostatic ligament were performed using Xi system significantly more often. The surgery duration was significantly shorter in the Xi-group. The postoperative recovery time and the incidence of postoperative complications appeared to be identical across both groups. No differences were revealed in the rates of positive surgical margins or biochemical recurrence.Discussion. Reasons behind the reduced operative time were considered as follows: first, the docking of the Xi system is more user-friendly, resulting in decreased docking time; second, the operational efficiency of the Xi system had been enhanced, thereby leading to reduced workflow times; third, a number of collisions between robotic arms was significantly lower during the procedure, which accelerates the surgical process.Conclusion. A robot-assisted radical prostatectomy performed by an experienced professional, using the Da Vinci Xi or Da Vinci Si surgical systems, appears to be safe and feasible without an increased risk of serious complications. However, the Xi system ensures better perioperative outcomes with comparable oncological results.

Renal cell carcinoma (RCC) has previously been considered as a single disease. However, it is currently characterized as a heterogeneous group of tumors that differ in histological features, genetic abnormalities, and variable clinical course. In normal cells, energy is produced by the cleavage of chemical bonds in nutrients through the oxidation of fats, proteins, or carbohydrates. Mutational alterations in genes associated with RCC, including VHL, FLCN, PTEN and SDH, lead to abnormal cellular adaptation to changes in oxygen status, iron metabolism and nutrients. The present paper reviews the known genetic abnormalities observed in RCC and their impact on metabolic alterations. Understanding the genetic and metabolic mechanisms underlying RCC is crucial for the development of effective therapies. Targeting specific genetic abnormalities or metabolic pathways represents a promising approach to the RCC treatment. In addition, studies into the metabolic basis of RCC contribute to the development of new biomarkers for early diagnosis and monitoring of the disease. Moreover, investigating the role of VHL, FLCN, PTEN, and SDH genes in the development of RCC provides valuable information on the molecular mechanisms behind the disease. As a result, it may lead to the development of new treatment strategies aimed at restoring the normal function of these genes or compensating for their abnormalities. Overall, an integrated approach to the study of RCC that considers genetic, metabolic, and clinical aspects will ensure that more effective treatments are developed and prognosis for patients with this disease are improved.