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Currently, due to the dynamic development of surgical technologies, indications for organ-sparing treatment of kidney cancer are expanding. Acute kidney injury is a serious complication that leads to chronic kidney disease, increased postoperative mortality, deterioration of long-term functional outcomes, and increased hospitalization. At present, it is known that even a slight damage to kidneys or their impairment, presented by a decreased urine output and change in blood biochemical parameters, entails serious clinical consequences and is associated with a poor prognosis. Damaging factors, when the kidney is exposed, initially induce molecular changes, which entail the production of certain biomarkers, and only after that clinical aspects of kidney damage develop. The causes of acute kidney injury can be different, from specific renal disorders (acute interstitial nephritis, vascular and glomerular lesions, prerenal azotemia, obstructive disorders) to toxic damages, direct trauma and surgical treatment. The development of acute renal injury in the postoperative period is a serious complication of the surgical treatment of kidney disease, and, according to various authors, the frequency of its occurrence varies from 5.5 % to 34 %. An active study of this problem made it possible to find specific biomarkers that give the possibility to predict and diagnose acute renal injury in the early stages, to optimize the treatment strategy, to reduce the incidence of postoperative complications, and to shorten the period of postoperative rehabilitation. Currently, the most studied of acute kidney injury (AKI) biomarkers are cystatin C, neutrophil gelatinase-associated lipocalin‑2 (NGAL), hepatic protein L-FABP, KIM‑1 (Kidney injury molecule‑1), Interleukin – 18. Further study of AKI biomarkers will make it possible to determine the most significant ones for subsequent use in everyday practice

Background. Prostate cancer is currently one of the most challenging problems in urological oncology due to its constantly increasing incidence and mortality in Russia. Surgery remains one of the most radical treatment options for patients with localized and locally advanced prostate cancer of any risk. Multiple studies have compared long-term and functional outcomes of surgeries performed using different surgical approaches. All studies have demonstrated similar long-term and functional outcomes of open, laparoscopic, and robot-assisted surgeries. Objective: to review the existing literature on this problem and analyze outcomes of surgical treatment in patients who had undergone open or laparoscopic prostatectomy in one of three federal centers of the National Medical Research Radiology Center.Materials and methods. This retrospective study included 2,772 patients with localized and locally advanced prostate cancer who had undergone surgery in one of the three federal centers.Results. We evaluated short-term and long-term outcomes of laparoscopic and open radical retropubic prostatectomy (RRP) performed at three federal centers of the National Medical Research Radiology Center. We found that laparoscopic RRP was associated with a longer surgery, lower blood loss, and fewer lymph nodes removed compared to open RRP. Long-term oncological and functional outcomes (prostate-specific antigen relapse-free survival, time to urination recovery) did not significantly differ between patients who had laparoscopic or open RRP.Conclusion. Both open and laparoscopic RRP are equally effective surgical methods for patients with localized and locally advanced prostate cancer.

Prostate cancer (PCa) is one of the most common malignant tumor in men. Significant advances have been made in the early detection and treatment of localized PCa, but metastatic castration-resistant PCa (mCRPC) remains one of the most challenging problems to treat in oncology. To improve treatment outcomes for patients at this stage of the disease, it is necessary to develop personalized therapy options based on the definition of biological predictors. In mCRPC, mutations in DNA repair genes are detected in ~23 % of patients with mCRPC. Detection of these mutations in patients with PCa has important clinical relevance. PCa with mutations in DNA repair genes may be sensitive to poly(ADP-ribose)-polymerase (PARP) inhibitors. Several studies II and III phase have demonstrated the effectiveness of PARP inhibitors with a high objective response rate in the treatment of mCRPC in patients with mutations in the DNA repair genes, which is definitely a more personalized approach to treatment. Identification of hereditary mutations in DNA repair genes is an important prognostic factor for the proband's relatives (for both men and women), which can later be used for genetic counseling of patients and the application of strategies to reduce the risk of malignant diseases.

Androgen deprivation therapy (ADT) is one of the main treatments for patients with locally advanced and metastatic prostate cancer. ADT decreases the level of testosterone. Despite the development of new effective drugs in recent years, luteinizing gonadotropin-releasing hormone agonists are frequently administered as ADT. One of the most commonly used first-line drugs is triptorelin (Diferelin®). In Russia, patients usually receive slow-release triptorelin administered once every month or every 3 months (intramuscular injections) and once every 3 months (subcutaneous injections); the result of using different dosage forms is comparable. Triptorelin effectively keeps serum testosterone level below 20 ng/dL, thereby increasing the time to development of castration-resistant prostate cancer, overall survival of patients receiving combination treatment with radiotherapy, and reduces the severity of symptoms from the lower urinary tract. Triptorelin has a good safety profile and is generally well tolerated by patients.

Background. Prostate cancer (PCa) remains one of the most relevant problems in oncology. The incidence and mortality of PCa is constantly rising in Russia. The rate of annual increase in the number of new PCa cases is the highest among all malignancies in Russia and reaches 87.7 % over 10 years (from 2008 to 2018). Approximately one-third of patients have high-risk PCa. This article analyzes the outcomes of surgical treatment in high-risk PCa patients. Objective : to evaluate survival of patients with high-risk PCa after surgical treatment and analyze prognostic factors affecting survival. Materials and methods. This retrospective study included 1507 high-risk PCa patients who have undergone surgical treatment at P.A. Herzen Moscow Oncology Research Institute. Study participants were divided into groups to assess the effect of preoperative prognostic factors on patient survival after surgery. The following factors were analyzed: level of prostate specific antigen >20 ng/mL, Gleason score 8—10, and сТ3—4 clinical stage. Results . Median follow-up time was 58 months. The five-year biochemical relapse-free survival rate in the general group was 57.4 %; five-year overall and cancer-specific survival rates were 94.4 % and 97.7 %, respectively. The incidence of biochemical relapses and survival rates depended on the presence and number of risk factors in the groups studied (p

Objective: to assess the potential clinical significance of KIM-1 (kidney injury molecule 1) as a urinological marker for kidney cancer.Materials and methods. An enzyme-linked immunosorbent assay was used to assess urinary KIM-1 (uKIM-1 — kidney injury molecule 1) levels in 67 patients with renal cell carcinoma (RCC) and 36 healthy volunteers (a control group).Results. Both in patients and in healthy individuals, uKIM-1 levels were age independent. A difference between mean uKIM-1 values in RCC patients (2.4 ± 0.2 ng/ml) and the control group (0.7 ± 0.1 ng/ml) was statistically significant (p Conclusion. This study demonstrates that uKIM-1 can be attributed to potentially significant urine tumor-associated markers of RCC.

Objective: to study the clinical and demographic profile of patients with non-metatstatic castration-resistant prostate cancer (nmCRPC) and clinical approaches to the treatment of nmCRPC in the context of daily medical practice before and after progression M1 stage.Materials and methods. The multicenter non-interventional epidemiological study is planned to include 200 patients with a documented diagnosis of nmCRPC from 2019 to 2020. The interim report has included data on 108 patients from 13 centers located in different regions of the Russian Federation. The median age of the patients was 73 (55—90) years.Results and conclusion. When the diagnosis of nmCRPC was made, the median prostate specific antigen was 8.23 (0.17—116.9) ng/ml, and the prostate specific antigen doubling time was 6 (1—50) months. When diagnosed nmCRPC, 86 patients (79.6 %) underwent a change of therapy, of which 42 % were prescribed modern regimens containing the new generation non-steroid antiandrogens (apalutamide, enzalutamide).

This literature review describes various surgical techniques that reduce the urinary incontinence chance after orthotopic plastic surgery of the bladder by Studer. Satisfactory retention of urine is possible in case of maintaining the maximum length of the urethra, consistency of vesico-urethral anastomosis, sufficient volume of neocystis with low pressure, as well as functional and morphological adaptation of the intestinal wall. The techniques that help to reduce tension in the region of the vesico-urethral anastomosis and pressure in a short mesentery, preservation of functional urethral length by "secondary sphincter" using, attention is paid to some exposure characteristics of the ileum segment of sufficient length for the formation of neocities a satisfactory amount of, performing neotestamentaria during robot-assisted of cystoplasty, comparing the surgical techniques, as well as possible the feasibility of using suture V‑loc. A modified method for forming a robot-assisted anastomosis for laparoscopic operations is described. The results of clinical studies are presented, in one of which the results of modification of the "non-hole" technique are considered, and in the other — the method of temporary tension of the anastomosis zone. The article describes the experience of forming a vesico-urethral anastomosis using a CAPIO cross-linking device, as well as the experience of reconstructing The denonvillier fascia intraoperatively. An artificial device to achieve urinary retention: the artificial urinary sphincter (AUS).

At the present time primary-multiple malignancies are of interest in connection with the frequency of prevalence, which remains at the rather high level and continues to grow up, therefore increasing the relevance of this pathology in clinical oncology and everyday practice. With the exception of the treatment of primary multiple malignancies requiring a multimodal approach, as well as in the case of the use of complex treatment in conjunction with chemotherapists and radiotherapy specialists. In the past three decades, the development of screening tests that prevent and detect some cancers at an early, more treatable stage, and treatment advances have increased the 5‑year relative survival rate for all cancers to 66%. In addition to concerns about cancer recurrence, survivors also worry about their risk of developing a new cancer. Prostate cancer is a leader in terms of morbidity and mortality in the world, just as often are found in combination with other malignant tumors. However, given the high detectability of prostate cancer, primary patients are currently receiving radical treatment, and if metastatic prostate cancer is detected, they are receiving drug treatment, which improves the survival and quality of life of patients. Soft tissue sarcomas are rare malignant tumors that develop in the connective tissues and remain poorly understood due to the fact that they make up less than 1% of all malignant diseases. One of the main methods for treating soft tissue sarcomas is the surgical method. Soft tissue sarcomas are difficult to treat and therefore it is imperative that surgeons and other specialists have experience in treating this disease. Studies show that patients with this pathology show better results if they receive treatment in specialized cancer centers that have experience in treating soft tissue sarcoma. This article demonstrates the clinical case of surgical treatment of a patient with primary multiple retroperitoneal tumors and metastatic prostate cancer.

Prostate cancer is one of the most actual oncourological diseases because of the persisting high rates of morbidity and mortality from this pathology. More than 1 100 000 new cases of this pathology are registered in the world every year. The incidence of prostate cancer in the Russian Federation continues to increase steadily. Despite the success in early detection of this disease, primarily due to the introduction of diagnostics with the use of a specific prostatic antigen, the frequency of detection of primary metastatic cancer of the prostate gland remains high and is about 20%. Metastatic castration-resistant prostate cancer is an extremely heterogeneous disease with an unfavorable prognosis in most of these patients, which requires a differentiated approach when prescribing therapy in each case. Despite the standard approach to prescribing chemotherapy as one of the main methods of drug treatment, the method of hormonal therapy of the second line using drugs aimed at the androgenic mechanism of cellular proliferation regulation is an effective and less toxic option. A fundamentally different mechanism of action has a new drug hormonal therapy of the second line enzalutamide, which is able to selectively block androgen receptors and disturb the translocation of the signal from the receptor into the cell and the cell nucleus. A number of large randomized trials that studied the effectiveness of this drug have allowed to register it for clinical use, including in our country. The article presents a review of the literature on the use of enzalutamide in patients with metastatic castration-refractory prostate cancer, as well as a description of the clinical case of the use of this drug in real practice.

Prostate cancer (PC) is one of the most pressing problems of modern oncology due to high worldwide morbidity for this pathology. Annually, more than 1,100,000 new cases of PC are diagnosed worldwide. The main treatment method for patients with locally advanced and/or metastatic PC is hormone therapy. Androgen deprivation allows to achieve disease stabilization in more than 90 % of patients, but mean time to progression after hormone therapy in patients with metastatic PC is about 2 years. Patients with cancer progression and preserved castration level of testosterone transition to the stage of so-called castration-resistant prostate cancer (CRPC). Advanced CRPC not only has poor prognosis, it also significantly decreases quality of life of the patients. CRPC patient cohort is extremely heterogenous and included patients both with factors of favorable prognosis and fulminant course of the disease. Unfavorable prognostic factors for patients with metastatic CRCP are short response time for initial hormone therapy (

This article presents a clinical case demonsratinga high metastatic potential of clear cell renal cell carcinoma combined with atypical metastases to breast and paranasal sinuses. The prevalence of metastatic lesions to the breast and paranasal sinuses in various malignant tumors depending on their morphological forms is analyzed. The authors present an analysis of data published for the last 30 years. The optimal diagnostic algorithms to detect the progression of renal cell carcinoma and to evaluate the effectiveness of the treatment are considered.

Prostate cancer (PC) is the most pressing oncourological pathology due to a steady increase in morbidity and mortality from this pathology in the Russian Federation. The detection frequency of the common forms of the disease remains high. The combined chemo-hormonal therapy is the main method of treatment of metastatic prostate cancer. The refractoriness of the tumour to the ongoing castration therapy is an inevitable stage of the course of the disease in all patients receiving androgen deprivation therapy. However, castration therapy aimed at reducing endogenous testosterone in this cohort of patients should be continued. Eligard is one of the most studied drugs to conduct the drug castration therapy in patients with prostate cancer, which efficacy has been proven in numerous clinical studies in both continuous and intermittent mode using depot forms of various durations of action. The article presents a review of clinical studies that assessed the efficacy of Eligard therapy in different regimens and with the use of depot forms of various duration, which demonstrated equal effectiveness of such forms.

Background. The approach to the management of prostate cancer with lymph node metastases has recently moved towards aggressive multimodal treatment with the use of the most rational combinations that are currently available.Objective: to assess the efficacy and tolerability of chemohormonal therapy (CHT) in patients with high-risk and very high-risk prostate cancer.Materials and methods. An open prospective clinical trial evaluating the efficacy and tolerability of neoadjuvant and adjuvant CHT in patients with high-risk and very high-risk prostate cancer was initiated in 2016 at the P.A. Herzen Moscow Oncology Research Institute. Patient recruitment is still ongoing.A total of 64 patients with high-risk and very high-risk prostate cancer (сT3N0–T3N+М0, prostate specific antigen (PSA) ≥20 ng/mL, and Gleason score of 8–10) were recruited since July 2016. All patients were examined prior to treatment initiation and after 3 and 6 courses of therapy. The examination included pelvic magnetic resonance imaging, ultrasound imaging of the abdominal cavity and retroperitoneal space, transrectal ultrasound imaging, and chest radiography or computed tomography. Serum PSA level was evaluated before each course of therapy. Bone scintigraphy was performed before treatment and after its completion. Study participants were divided into two groups. Group A included patients that initially underwent surgical treatment and then 6 courses of CHT no later than 6 weeks after surgery: docetaxel 75 mg/m2 given intravenously on day 1 of a 21-day cycle and oral prednisolone 10 mg/day. Patients also received hormonal therapy with luteinizing hormone-releasing hormone analogue (aLHRH) given in depot injections every 28 days.Group B included patients that initially received 6 courses of CHT: docetaxel 75 mg/m2 given intravenously on day 1 of a 21-day cycle and oral prednisolone 10 mg/day. After that, patients underwent radical prostatectomy with pelvic lymphadenectomy no later than 4 weeks after the completion of chemotherapy. Patients also received hormonal therapy with aLHRH given in depot injections every 28 days. The total treatment duration was 6 months.Results. The group of adjuvant CHT included 24 patients with high-risk prostate cancer (T3b–4N+М0 with at least 5 regional lymph node metastases detected by morphological examination of surgical specimens). All patients had Gleason score 8–10 tumors. Mean age of patients was 63.0 ± 7.7 years (range: 46–72 years). In total, all patients received 142 courses of CHT. By the time of publishing this article, 23 (96 %) of patients completed their treatment.The group of neoadjuvant CHT included 40 patients with very high-risk prostate cancer (T3b–4N+М0 with metastases to pelvic and retroperitoneal lymph nodes detected by instrumental examination). All patients had Gleason score 8–10 tumors. Mean age of patients was 61.0± 6.4 years (range: 43–69 years). In total, all patients received 236 courses of CHT. By the time of publishing this article, 36 (90 %) of patients completed their treatment. Thirty-five patients (87 %) underwent radical prostatectomy with extensive pelvic and paraaortic lymphadenectomy. Routine pathological examination demonstrated that all patients had signs of tumor destruction. Thirty-three participants (94 %) had grade II therapeutic pathomorphosis, whereas 2 patients (6 %) had grade III therapeutic pathomorphosis.Median PSA relapse-free survival (PSA-RFS) rate in the neoadjuvant CHT group was 10 months. Serum PSA of 0.1 ng/mL 1 month postoperatively correlated with longer RFS (р = 0.04). Biochemical relapse (PSA level >0.2 ng/mL) was observed in 6 patients (15 %) from this group. Later these patients received hormonal therapy with aLHRH. Median PSA-RFS in the adjuvant CHT group was 11 months.The main adverse events in the two groups were hematological toxicity, observed in 24 patients (34.29 %), and gastrointestinal toxicity, observed in 9 patients (12.86 %) (diarrhea (n = 6) and stomatitis (n = 3)). Only grade I–II toxicity was registered so far. Two patients (3.1 %) had febrile neutropenia, which required cytostatic dose reduction by 20 %. Relatively good tolerability and acceptable quality of life allowed the vast majority of patients to be treated on an outpatient basis.Conclusion. So far, we can make only a preliminary conclusion that adjuvant and neoadjuvant CHT is a promising treatment strategy for high-risk and very high-risk prostate cancer.

The majority of patients with metastatic renal cell carcinoma (mRCC) are in the groups of favorable or moderate prognosis per the MSKCC (MemorialSloan-KetteringCancerCenter) criteria, but in 20–30 % of poor-prognosis patients aggressive, rapidly progressing mRCC is observed. Despite improved prognosis in mRCC patients due to targeted therapy, this patient group remains hard to treat with overall survival 6 months) was higher in the temsirolimus (32.1 %) and combination (28.1 %) groups compared to the IFN-α group (15.5 %; р

Prostate cancer (PC) is one of the most urgent problems of modern urologic oncology in Russia because of a steady rise in morbidity and mortality rates associated with this disease. Radical prostatectomy (RP) and external beam radiotherapy (EBRT) or brachytherapy are mainstay treatments in patients with localized and locally advanced PC. Just the same, the rate of lymphogenic disease progression after radical treatment is as high as 15–40 %. At the same time, a search for a tumor focus leading to an increase in the marker is extremely important. If a local recurrence is detected after previous RP, there may be salvage EBRT. After verifying the relapse after salvage EBRT or brachytherapy, RP may be recommended to patients in the specialized centers having appropriate experience with this type of surgery. In patients with distant metastases, palliative hormonal therapy has been the only conventional method so far. Nonetheless, in a considerable number of patients, a marker recurrence may be associated with the so-called oligometastatic progression of the disease, in which the number of detected metastatic foci is minimal. The clinical introduction of promising and precise diagnostic methods having high sensitivity and specificity even with the minimal levels of prostate-specific antigen, such as magnetic resonance imaging and positron tomography, could substantially increase the number of detectable patients with oligometastases and propose new therapeutic conceptions for the treatment of this contingent of patients. Recently, in the literature there have been increasingly more works suggesting the possibility of using local treatments (surgery or radiotherapy) in patients with oligometastases when the disease progresses after radical treatment. The results of investigations show that a personalized approach and surgical or radiation treatments in selected patients make it possible to increase survival prior to the use of hormonal treatment and, in a number of cases, to completely abandon the latter. The paper gives a review of the literature data dealing with this problem.

Over 200,000 new cases of renal-cell carcinoma (RCC) are notified worldwide every year. Examinations diagnose metastatic RCC (mRCC) in 25 % of primary patients; and after radical surgery 20–40 % of the patients are further diagnosed with disease progression and metastases. Randomized trials have demonstrated the efficacy of tyrosine kinase inhibitors in treating mRCC. Clinical trials are conducted on a carefully selected population of patients; the latter have generally clear-cell RCC without brain metastases and a good somatic status. In real clinical practice, the population of patients with mRCC is more heterogeneous; there are patients with non-clear cell mRCC, brain metastases, and an ECOG somatic status > 1; this raises the question as to whether it is effective and appropriate to use target agents in these patient groups.The paper gives the data of performed clinical trials using sunitinib with expanded inclusion criteria and those of non-randomized trials that have proven the clinical efficacy of the drug in patients with a poor prognosis, non-clear cell mRCC, and brain metastases, as well as in the elderly. Despite lower objective response rates, the progression-free survival rates in this category of patients have proven to be comparable to those in patients with clear cell mRCC.

Objective: to investigate the safety of vinflunine, the rate and duration of its treatment response, progression-free and overall survival rates in patients receiving this drug in routine clinical practice for first-line chemotherapy (CT) – resistant disseminated transitional cell carcinoma of the urinary tract. Materials and methods. This retrospective observational multicenter study included data on 25 patients with verified disseminated transitional cell carcinoma of the urinary tract who took vinflunine for tumor progression after first-line CT performed in 11 Russian clinical centers in 23 March 2013 to 26 June 2016. The median age of the patients was 60 (44‒81) years. Their baseline somatic status was rated as ECOG 0 in 1 (4.0 %) patient, ECOG 1 in 13 (52.0 %) patients, EGOG 2 in 9 (36.0 %), and ECOG 3 in 2 (8.0 %). The most common sites of tumor foci were bones (n = 14, 56.0 %), lymph nodes of different groups (n = 14; 56.0 %), and lung (n = 9; 36.0 %). Results. Adverse reactions were recorded in 24 (96.0 %) cases. The most common types of toxicity were asthenia (n = 19; 76.0 %), anemia (n = 18; 72.0 %), neutropenia (n = 13; 52 %), and nausea (n = 12; 48.0 %). Most adverse events were grades I–II and well controlled. There were no deaths due to adverse events. The best treatment response was regarded as partial in 6 (24.0 %) patients; stabilization and progression were observed in 10 (40.0 %) and 9 (36.0 %) patients, respectively. The median duration of partial response was 5.1 (95 % confidence interval (CI), 0.6–15.0) months; that of stabilization was 3.4 (95 % CI, 1.2–6.3) months. In all the 25 cases, the median progression-free and overall survival rates were 3.7 (95 % CI, 2.1‒5.3) and 6.5 (95 % CI, 5.2‒7.8) months, respectively. The somatic status was a predictor of overall survival (p < 0.0001). Conclusion. The efficacy and safety of vinflunine in second-line therapy for first-line CT-resistant disseminated transitional cell carcinoma of the urinary tract in unselected patients agree with those previously observed in Phase III randomized trial.

Renal cell carcinoma (RCC) takes one of the leading places in the world incidence among malignant tumors of the genitourinary system. Metastatic renal cell cancer (mRCC) is detected in about 25–30 % of primary patients. 10 targeted immuno-oncology drugs for the treatment of mRCC were registered and approved for use from 2005 till the present time. Rapid growth of therapeutic options of mRCC treatment has created a problem for practicing oncologists and urologists as well as necessity to understand the principles and consistent optimization of targeted therapy to maximize the effectiveness of each treatment line. The article discusses issues of the correct choice of first-line targeted drugs, optimal dosing of sunitinib and aksitinib, alternative modes and alternating use of sunitinib, as well as the influence of objective response and hypertension, which developed on the background of the targeted therapy on the effectiveness of treatment.

Prostate cancer (PC) is one of the most actual problems of modern oncourology. Hormone therapy (HT) using medical castration is the main method of treatment of patients with metastatic PC. HT with usage of the new class of drugs that block the receptors for luteinizing hormone releasing hormone (LHRH) is a promising and effective method of castration therapy that has a number of significant advantages over the use of analogues LHRH. This article presents a review of studies that compared the effectiveness and side effects of HT using antagonists and analogues LHRH.

Cytoreductive nephrectomy as an independent option in patients with metastatic renal cell carcinoma (mRCC) cannot be considered as the only effective method, with rare exception, of a few patients with solitary metastases. Cytoreductive nephrectomy is now part of a multimodal approach encompassing surgical treatment and systemic drug therapy. Many retrospective and two prospective studies have demonstrated that it is expedient to perform cytoreductive nephrectomy. Immunotherapy should not be used as preoperatively in the era of cytokine therapy for mRCC due to that fact that it has no impact on primary tumor. In the current targeted therapy era, many investigators have concentrated attention on the role of neoadjuvant targeted therapy for the treatment of patients with both localized and locally advanced mRCC. The potential benefits of neoadjuvant therapy for localized and locally advanced RCC include to make surgery easier and to increase the possibility of organsparing treatment, by decreasing the stage of primary tumor and the size of tumors. The possible potential advantages of neoadjuvant targeted therapy in patients with mRCC include prompt initiation of necessary systemic therapy; identification of patients with primary refractory tumors; and a preoperative reduction in the stage of primary tumor. Numerous retrospective and some prospective phase II studies have shown that neoadjuvant targeted therapy in patients with localized and locally advanced RCC is possible and tolerable and surgical treatment after neoadjuvant targeted therapy is safe and executable with a low incidence of complications. If neoadjuvant therapy is to be performed, it should be done within 2–4 months before surgery. Sorafenib and sunitinib are now most tested and suitable for neoadjuvant targeted therapy. Sorafenib is a more preferred drug due to its shorter half-life and accordingly to the possibility of discontinuing the drug immediately prior to surgery. Unquestionably, elaboration of precise recommendations for neoadjuvant therapy calls for further larger prospective studies estimating progression and survival rates in high-risk patients with localized and locally advanced RCC and in those with mRCC.