Multiparametric magnetic resonance imaging (mpMRI) has emerged as a first-line screening and diagnostic tool for prostate cancer, aiding in treatment selection and noninvasive radiotherapy guidance. However, the manual interpretation of MRI data is challenging and time-consuming, which may impact sensitivity and specificity. With recent technological advances, artificial intelligence (AI) in the form of computer-aided diagnosis (CAD) based on MRI data has been applied to prostate cancer diagnosis and treatment. Among AI techniques, deep learning involving convolutional neural networks contributes to detection, segmentation, scoring, grading, and prognostic evaluation of prostate cancer. CAD systems have automatic operation, rapid processing, and accuracy, incorporating multiple sequences of multiparametric MRI data of the prostate gland into the deep learning model. Thus, they have become a research direction of great interest, especially in smart healthcare. This review highlights the current progress of deep learning technology in MRI-based diagnosis and treatment of prostate cancer. The key elements of deep learning-based MRI image processing in CAD systems and radiotherapy of prostate cancer are briefly described, making it understandable not only for radiologists but also for general physicians without specialized imaging interpretation training. Deep learning technology enables lesion identification, detection, and segmentation, grading and scoring of prostate cancer, and prediction of postoperative recurrence and prognostic outcomes. The diagnostic accuracy of deep learning can be improved by optimizing models and algorithms, expanding medical database resources, and combining multi-omics data and comprehensive analysis of various morphological data. Deep learning has the potential to become the key diagnostic method in prostate cancer diagnosis and treatment in the future.

Prostate cancer (PCa) is a prevalent malignancy with increasing incidence in middle-aged and older men. Despite various treatment options, advanced metastatic PCa remains challenging with poor prognosis and limited effective therapies. Nanomedicine, with its targeted drug delivery capabilities, has emerged as a promising approach to enhance treatment efficacy and reduce adverse effects. Prostate-specific membrane antigen (PSMA) stands as one of the most distinctive and highly selective biomarkers for PCa, exhibiting robust expression in PCa cells. In this review, we explore the applications of PSMA-targeted nanomedicines in advanced PCa management. Our primary objective is to bridge the gap between cutting-edge nanomedicine research and clinical practice, making it accessible to the medical community. We discuss mainstream treatment strategies for advanced PCa, including chemotherapy, radiotherapy, and immunotherapy, in the context of PSMA-targeted nanomedicines. Additionally, we elucidate novel treatment concepts such as photodynamic and photothermal therapies, along with nano-theragnostics. We present the content in a clear and accessible manner, appealing to general physicians, including those with limited backgrounds in biochemistry and bioengineering. The review emphasizes the potential benefits of PSMA-targeted nanomedicines in enhancing treatment efficiency and improving patient outcomes. While the use of PSMA-targeted nano-drug delivery has demonstrated promising results, further investigation is required to comprehend the precise mechanisms of action, pharmacotoxicity, and long-term outcomes. By meticulous optimization of the combination of nanomedicines and PSMA ligands, a novel horizon of PSMA-targeted nanomedicine-based combination therapy could bring renewed hope for patients with advanced PCa.

Recent immunotherapy research has focused on chimeric antigen receptor-modified T cells (CAR-Ts). CAR-T therapies have been clinically applied to manage hematologic malignancies with satisfactory effectiveness. However, the application of CAR-T immunotherapy in solid tumors remains challenging. Even so, current CAR-T immunotherapies for prostate cancer (PCa) have shown some promise, giving hope to patients with advanced metastatic PCa. This review aimed to elucidate different types of prostate tumor-associated antigen targets, such as prostate-specific membrane antigen and prostate stem cell antigen, and their effects. The current status of the corresponding targets in clinical research through their applications was also discussed. To improve the efficacy of CAR-T immunotherapy, we addressed the possible applications of multimodal immunotherapy, chemotherapy, and CAR-T combined therapies. The obstacles of solid tumors were concisely elaborated. Further studies should aim to discover novel potential targets and establish new models by overcoming the inherent barriers of solid tumors, such as tumor heterogeneity and the immunosuppressive nature of the tumor microenvironment.

Дисфункция тазового дна остается камнем преткновения в хирургической практике гинеколога, а число пациенток с пролапсом гениталий только увеличивается. Имеющиеся исследования описывают патогенетическую взаимосвязь формирования цистоцеле с апикальным пролапсом гениталий, которая наблюдается у 20% больных с опущением органов малого таза. Использование синтетических материалов открыло множество возможностей для его хирургической коррекции. Однако первые отдаленные результаты потребовали приостановить использование синтетических материалов в ряде стран и провести исследования по поиску компромиссных решений с целью минимизации количества ятрогенных осложнений. ЦЕЛЬ ИССЛЕДОВАНИЯ Сравнить отдаленные результаты вагинальной кольпопексии с использованием сетчатого имплантата с миниинвазивной абдоминальной сакрокольпопексией у пациенток с переднеапикальным пролапсом гениталий. МАТЕРИАЛ И МЕТОДЫ Сравнительное нерандомизированное ретро- и проспективное многоцентровое исследование, включавшее 192 пациенток с переднеапикальным пролапсом гениталий III—IV стадии, у которых проведено оперативное вмешательство в период с 2013 по 2021 г. на базе 3 клиник: Московского областного НИИ акушерства и гинекологии, клиники урологии Сеченовского Университета, клиники «Москворечье». В 1-й группе (n=112) была проведена вагинальная кольпопексия сетчатым имплантатом Opur, во 2-й (n=80) — лапароскопическая сакрокольпопексия. РЕЗУЛЬТАТЫ Медиана длительности послеоперационного наблюдения пациенток составила 48,2 [34,3; 64,0] и 50,0 [31,7; 78,5] мес в 1-й и 2-й группах соответственно. Было выявлено 7 (6,3%) наблюдений рецидива в группе вагинальной кольпопексии и 13 (16,3%) — после сакрокольпопексии. По результатам анкетирования 1-я группа показала лучший результат по индексам PFDI-20 и PISQ-7 (96,4 и 91,1% пациенток соответственно), во 2-й группе при этом отмечена большая частота клинического улучшения согласно PISQ-12 (94,7%). У пациенток, перенесших влагалищную коррекцию пролапса гениталий, отмечено 4 (3,6%) случая экструзии сетчатого протеза (3 эрозии влагалища и 1 экструзия протеза в просвет мочевого пузыря), а после промонтофиксации таковые отсутствовали. ЗАКЛЮЧЕНИЕ На выбор доступа предстоящей коррекции переднеапикального пролапса влияет следующий ряд факторов: соматическая патология, хирургический анамнез, тип дефекта фасции Гальбана, соотношение цистоцеле и гистероптоза между собой, возраст и наличие половой жизни.

Background. Pelvic floor muscle exercises are used as a first-line treatment for urinary incontinence after radical prostatectomy. Their efficacy is still being investigated. The use of biofeedback when teaching pelvic floor muscle exercises to patients increases the effectiveness of therapy.Objective: to assess the efficacy of biofeedback-assisted pelvic floor muscle training in patients with urinary incontinence after laparoscopic and robot-assisted radical prostatectomy and to compare the results of teaching.Materials and methods. A total of 64 patients with urinary incontinence after nerve sparing prostatectomy underwent biofeedback-assisted pelvic floor muscle rehabilitation. Radical laparoscopic surgery was performed in 48 (75 %) patients, whereas robot-assisted surgery was performed in 16 (25 %) patients. The patients started their training 2 months postoperatively. We used two-channel electromyography with the Neurotrack ETS system (United Kingdom) to teach the patients isolated pelvic floor muscle contractions. After achieving a minimum activity of abdominal muscles during pelvic floor muscle contractions, the patients started exercises.Results. There was no significant difference in age between patients who underwent laparoscopic and robot-assisted radical prostatectomy (р = 0.79). Fifty-five patients (85.9%) acquired the skill of isolated pelvic floor muscle contractions and could perform training on their own. The remaining 9 patients (14.1 %) required regular support from healthcare professionals at an outpatient unit (1–2 biofeedback-assisted trainings per month). Thus, the type of surgery did not affect the process of training. The type of radical prostatectomy had no impact on the acquisition of the pelvic floor muscle contraction skill.Conclusion. The time for restoration of urinary continence by biofeedback-assisted pelvic floor muscle training did not vary between patients after laparoscopic and robot-assisted radical prostatectomy.

Малоинвазивное хирургическое лечение женской гипоспадии и гипермобильности уретры, осложненных посткоитальной дизурией