— How often do you perform surgeries?
— Almost daily. I actually performed three major surgeries today. It’s not a normal routine. Usually there are fewer operations a day. Of course, I'm exhausted and somewhat frustrated that there were none yesterday and three today. But it's my job — I love it and strive to do it well.

— What do you feel in the operating room?
— Do you like doing things by hand? Seriously, surgery feels like an addiction.
If I have a day without surgeries, it’s alright. I can then take some time to write because I am a researcher and spend a lot of time doing science. We analyze and summarize the results of hundreds of our surgeries and collaborate with molecular biologists. For instance, we study the characteristics of kidney cancer cells.
But if there are no surgeries for two days, I start to feel depressed. I feel unneeded, as if life is passing me by, and I haven't been in the operating room yet today. Many surgeons experience something like this. When there are too many surgeries, it's tough. But when there is a break, it feels like life is over, everything is lost, and I need to rush to the operating room to regain that drive again.
Do you know the difference between a surgical oncologist and a chemotherapist? A chemotherapist prescribes therapy and then waits for three months for the results. We, on the other hand, see immediate consequences. You perform a successful surgery and you know for certain that you've removed the tumor. There is nothing more thrilling than doing something with your own hands and seeing that you've made a difference. This feeling is like no other.
In short, it's never dull, and the work is very diverse. It's actually difficult for me to call myself just “a doctor” because research is also a significant part of my job.

— Why did you choose urologic surgical oncology?
— I didn’t plan it specifically. Unlike my peers who had a clear vision of becoming cardiac surgeons from year one. For the longest time I was unsure about my career path, and it caused me a great deal of anxiety. I chose to simply study. The first three years of medical school are dedicated to, let me call them, foundational, general subjects such as biology, chemistry, Latin language, general anatomy, and so on. Starting from the fourth year, students begin to rotate through different departments and study various disease groups. Urology was the first department I was assigned to, and the vibrant teaching approach there captivated me towards this major. Upon my graduation, there were no available spots in the residency program in urology, so I was recruited into an oncology center. At first, I was horrified. I wanted to delve into the subtle aspects of medicine, but oncology at that time was predominantly about organ removal surgeries. However, the department I joined had an exceptional surgical school, it was impossible not to be drawn to that branch of surgery.

— What is surgical oncology capable of nowadays?
— Surgical oncology is currently at its height. Thanks to advancements in diagnostics, we are now detecting localized tumors more frequently and have mastered the art of delicately removing small tumors. Hence, there is a significant trend in oncology towards using organ-preserving treatment methods that maintain the functions of the organ. This includes tumors in the kidneys, stomach, lungs, bones, and even remarkable surgeries on the spine that preserve spinal functions. Patients who were previously unable to move their legs can rise post-surgery, like Lazarus, with restored functions of their lower limbs and pelvic organs. This trend has a profound impact on improving patients' quality of life.

— Have robots ever assisted you during surgeries?
— Yes, for instance, during prostatectomies for patients with prostate cancer or during kidney resections in patients with kidney cancer. Nowadays, many patients insist on being operated on by a robot, believing that robots are the future of surgery. However, the reality is that the surgeon still performs the operation, and only a specifically trained surgical oncologist surgeon can properly remove a tumor.

— How does a surgeon collaborate with a robot during surgery?
— Whether you eat porridge with your hands, a spoon, or chopsticks, these are just different methods of getting food into your mouth. The same principle applies to surgical methods. We have the option to make a large cut, hold the tool in our hands, and look down in the wound. This is referred to as open surgery. Alternatively, we can create small punctures in the body, insert a camera and tool into the cavity, and perform the operation endoscopically while looking at a monitor.
Or, we can operate from a robot control console, where the robot will hold the camera and surgical tools. The surgeon's hands are limited in terms of angle, but the robot's “arms” can rotate the instruments at any angle, providing us with great maneuverability and the ability to perform complex manipulations. Another significant detail is that this method allows us to see nerves and vessels that we would otherwise have to bypass blindly during open surgery. It's simply revolutionary!

— What other techniques are available to modern oncology?
— Oncology originated from surgery. Because the simplest possible action is to mechanically remove the malignant tumor. However, a tumor can only be completely removed when it is operable and when we talk about one piece, one tumor. At most, there can be two of them. In other cases, attempts at radical surgical treatment can be likened to torture. It is as difficult as trying to rid a dog of fleas by catching each one individually.
What is necessary is a systemic approach that suppresses all tumor cells. This concept guided the development of drug therapy in oncology, also known as chemotherapy. The goal is to find drugs that only target rapidly growing cells. Chemotherapy continues to be widely used and beneficial to the patients, but it affects too broad a spectrum by destroying not only tumor cells but also bone marrow cells, hair follicle cells, and so on.
Therefore, alternative methods of systemic tumor targeting were sought. It was discovered that some tumors are influenced by the patient's hormone profile. The most notable examples are breast cancer and prostate cancer, for which hormone therapy was developed. Then a new discovery appeared. Scientists learned that if certain proteins produced on the surface of tumor cells are "switched off", the tumor cells will cease to grow and multiply. This led to the development of targeted therapy.

— What are those proteins?
— They are molecules that respond to signals sent by other cells. For instance, they respond to angiogenic signals that activate genes in the cell, promoting the growth of new blood vessels. In a healthy body, that signal is used to develop new blood vessels in tissue that is experiencing oxygen deficiency or ischemia. In a tumor, those ischemic conditions are simulated, even though they don't actually exist. However, the signal is conveyed, leading to the formation of a vast number of blood vessels in the tumor tissue. The vessels supply nutrients and oxygen to the tumor cells, which then start to grow and multiply. A cancer cell is distinct from a normal cell not just in its rapid growth and tendency to reproduce, it also has less attachment to the cells around it. As a result, cancer cells easily detach and then spread throughout the body via the bloodstream and lymphatic vessels, initiating metastasis.
But if we can identify the signaling molecules that instigate tumor growth, or the receptors on cell surfaces they bind to, it could indicate which molecule has the potential to halt the growth and reproduction of cancer cells. To suppress angiogenic signals that stimulate vessel growth, molecules have been developed that "switch off" receptors on cell surfaces capable of responding to those types of signaling molecules. Medications from this group, known as antiangiogenic drugs, are utilized across a broad range of malignant tumors. In addition to antiangiogenic therapy, there are other types of targeted drugs with proven efficacy.

— What triggers the disease? How does cancer develop?
— All cancer types roughly fall in two categories. The first category is sporadic cancers, where a genetic malfunction occurs in a cell that initially has a normal gene structure. There are significantly more patients of that type. Every day, genetic malfunctions occur in each of our cells, which are corrected by specialized systems designed to recognize those malfunctions and restore the normal DNA structure. However, if a genetic malfunction occurs that the body is unable to repair, pathological tumor proteins can be produced.
The second category is hereditary cancers, where a mutation, or a defect in a specific gene, is inherited, as was Angelina Jolie’s case. The story of how she had her breasts removed to prevent hereditary cancer made headlines worldwide. The risk of developing malignant tumors in such patients is indeed extremely high. Those patients require not just treatment, but also careful monitoring, as do their children, to ensure that malignant tumors are not overlooked. It is a whole field in itself called cancer genetics.

— Did Angelina Jolie make the right decision?
— One can opt for preventive surgery and then sleep peacefully. Or, one can live with the certainty of developing cancer, constantly undergoing medical examinations. Dynamic monitoring is an enormous psychological strain, which few people can endure.
It's difficult to sit on a ticking time bomb, knowing that it could explode at any moment. I believe that Angelina Jolie's case was exactly like that. Nowadays, even in our country, many patients with a similar mutation undergo prophylactic mastectomies and ovariectomies, choosing surgery over constant monitoring.

— Is it not yet possible to correct the genetic malfunction itself?
— We are still as far from gene therapy as we are from the Moon. However, the advancement in medicinal oncology is happening at an incredible pace! I have been practicing as a urologic oncologist for twenty six years now, and for twenty of those years, prostate cancer was treated in just one way, castration therapy. Over the past six years, six new drugs have emerged, and not just any drugs, but ones that belong to four new pharmacological groups. And that's just in the case of prostate cancer.
The development of new anticancer drugs is directly connected to a recent Nobel Prize. Cancer cells keep mutating, altering the characteristics of the tumor. When that mutation sequence was studied, it was found that the issue lies not only in the cancer cells themselves but also in our immune system. The more mutations in the tumor, the less effectively our immune system combats it. But why is that?
It turns out that as they mutate, tumor cells start to adapt to the immune response. Lymphocytes have a "friend or foe" recognition system that allows them to destroy cancer cells without harming each other. Like a dog, a lymphocyte sniffs every cell it encounters, comparing it with a sample provided by the recognition system, an antigen molecule. Like a tracker dog, it follows the scent and if it finds the same molecule on a cell it encounters, it eliminates that cell.
Interestingly, it was discovered that as mutations accumulate, cancer cells produce proteins that disrupt that system. When the transmission mechanism of the sample molecule, which is a tumor marker, is disrupted, our tracker can't find anyone because no antigen has been presented to it.
In 2018, immunologists James P. Allison and Tasuku Honjo were awarded the Nobel Prize for that mechanism discovery. I believe that even a Nobel Prize isn't enough here, those people deserve a monument! Thanks to them, universally applicable drugs have been developed that restore the immune response, proving effective against a vast number of malignant tumors. It is a fundamentally new direction in oncology, the third major breakthrough in cancer treatment following chemotherapy and targeted drugs.

— To me, cancer is something so terrifying that it's scary to even think about it...
— A malignant tumor is not a death sentence but a disease that can be and should be fought against. The prognosis is influenced by many factors, but primarily by the stage of the disease. Therefore, advancements in diagnostic methods and increased health awareness have significantly altered the statistics of malignant neoplasms. For instance, the statistics for prostate cancer in Russia are grim. Nearly 18% of patients have metastases at the time of diagnosis, compared to only 5% in the European Union. However, that means that almost 80% of diagnosed patients have only a primary tumor, which can be completely cured.

— So you're saying it's possible to completely eradicate cancer?
— Absolutely. Of course, any malignant tumor is automatically considered a chronic disease, and even if a person shows no signs of a tumor for ten years, they remain under regular medical supervision because there is always a risk of recurrence. Nevertheless, localized forms of malignant tumors are typically cured through surgical or combined treatment methods.
And, of course, we should discuss radiotherapy. I'm only mentioning it now due to my professional bias as a surgeon. It is a highly "equipment-dependent" specialty, and devices have been developed that operate with incredible precision, unmatched by a surgeon's scalpel unless they're using an operating microscope. People, however, often perceive radiotherapy as Garin's death ray burning a hole in the body roughly where the tumor is and the remainder of the body being sent to live out its days.

— By the way, how do they ensure there is no hole?
— Doctors use a special guidance system to focus the beam on a specific location without harming the skin, muscles, or surrounding organs. Such precision enables them to accurately irradiate the desired area and completely obliterate the malignant tumor without the need for a scalpel. In addition to radiation therapy, many patients are also given medication that makes living much harder for tumor cells, making the radiation therapy even more effective.
Innovative radiation therapy methods like stereotactic radiosurgery have been developed, allowing neurosurgeons to remove brain tumors in areas where it's generally impossible to use a scalpel, such as in the brain stem, near the centers controlling breathing and heartbeat.
Around 20 years ago, I defended my PhD thesis on treating cancer with brain metastases. I distinctly remember that patients who didn't receive treatment lived for three months, while those who underwent whole-brain radiation therapy — you can imagine the consequences — lived for six months. Surprisingly, patients who underwent surgery lived for 12 months. Those were the outcomes back then.
Nowadays, patients who have undergone stereotactic radiosurgery for brain metastases can live for years because nothing is damaged except for the metastasis area. Brain metastases are still a serious issue today, but they are no longer a death sentence.

— So localized forms of cancer can most often be cured, and in cases of cancer with metastases, a patient's life can still be extended for years, right?
— Well, all tumors are different. In my field of expertise, prostate cancer is one of the most prevalent malignant tumors in men. Prostate cancer patients who already have metastases at the time of initial diagnosis start systemic drug therapy, which allows them to live for two to three years with first-line treatment. The disease then adapts and devises ways to resist the therapy. The subsequent line of therapy gives us another year or so, and so forth... In Russia, we've already accumulated a group of patients who have undergone four to five lines of modern treatment and have lived for over five years.

— But aren't their lives filled with suffering?
— Don't imagine them as pitiful wreckages shuffling between chemotherapy and the bathroom. Those patients continue to work, support their families, go on vacation, and even demand documents from me stating that they can ski down Elbrus with a parachute! I'm not kidding, I actually received a request like that recently. I had to decline, saying I couldn't provide such a document. I believe such activities should be avoided altogether, even without having prostate cancer.
Before modern therapy regimes were introduced, kidney cancer patients lived on average about a year. Nowadays, a year is just the average duration of the first line of therapy. I'm not suggesting that our treatment is completely painless and goes unnoticed by patients. Of course, every therapy has its side effects. However, as oncologists gain more experience, we're learning alongside our patients how to combat those side effects and find ways to maintain the quality of extended lives. Patients don't need a prolonged life of poor quality. I know that from personal experience, no one wants to suffer. People want to live, work, and be socially active. We're currently making great strides in learning how to assist them in achieving that.
Sad as it is, we all suffer from some kind of chronic disease. Cancer is just one of them, nothing else.

— So, the key to combating cancer is early detection. But how should one go about getting diagnosed, and when and where should they go?
— Remember the Soviet-era health check-ups when everyone was bussed from work for fluorography or when medical teams would visit villages and conduct health screenings for the farmers? Things are not the same now. Health check-ups are promoted and encouraged, but ultimately, it's up to the individual. Our lives are so fast-paced that people often neglect their health and continue to think that they're sixteen even though they're actually forty. However, everyone should have a health check-up at least once a year, that is fair not only in case of cancer but also of heart diseases, for example. Imagine how many emergency medical situations could be avoided if people underwent regular screenings!

— Can a health check-up help detect urological cancers?
— That's a very crucial question you're asking. The traditional health check-up we're used to, blood tests, ECG, fluorography, and mammogram for women, won't necessarily detect early-stage kidney cancer. Health check-up programs and so-called screenings are designed based on whether it will be economically beneficial for the state to detect and treat the cancer earlier and at a lower cost. Often, what is included in a health check-up is what benefits the state, not necessarily the individual.
A classic case in point is prostate cancer screening. To save one life, a hundred patients need to be screened. It is considered economically unfeasible in both the US and the EU. However, in Belarus, they implemented mandatory prostate screening, and the mortality rate dropped significantly, proving to be quite profitable for the state.
Still, we don't go barefoot in winter just because the government doesn't provide us with boots. We buy our own shoes. So why can't we invest in our health? In my opinion, along with lung X-rays, it would be wise to perform ultrasound examinations of the abdominal and retroperitoneal areas. It could help detect early stages of many diseases, like kidney cancer.
Today, we often come across health-conscious patients who say, "I simply went for an ultrasound because I do it annually, and they found a one-centimeter tumor in my kidney that wasn't there last year." For a person to actually feel a tumor in the kidney, it has to be about ten centimeters, just imagine the difference! If a person comes in with symptoms, it's already too late for early detection. Please, if you notice blood in your urine or stool, see a doctor immediately, don't wait for it to go away. It might be a minor issue, but it's better to get it checked out.
The same goes for prostate cancer screening. It's not economically viable on a national scale for all men to take the PSA [prostate-specific antigen] test. But any man over 45 can afford to pay for this single test once a year, either for inner peace of mind or to consult a urologist about the necessary treatment.

— Is there anything specific that can be done for prevention?
— Unfortunately, I can't offer any advice on prostate and kidney cancer, as the main risk factors are sex, age, and genetics, factors we can't change. When it comes to bladder cancer, quitting smoking is crucial, as it continues to be a major trigger for the development of malignant tumors. Bladder cancer is a common disease among elderly smokers from the countryside who smoke unfiltered cigarettes and poor-quality tobacco. As for penile cancer prevention, you simply need good hygiene, but not everyone has even that bare minimum.
Despite the fact that people's attitudes towards their health have significantly changed over the years, it's still shocking to see the blatant disregard some have for their own wellbeing.

— Is it true that more and more younger adults are being diagnosed with cancer?
— I'm not a public health expert. We do have many young patients, but I believe it's not that cancer is affecting people who are younger, but rather that it's being diagnosed more frequently.
Lately, I've noticed a significant increase in pregnant women undergoing surgery for urologic cancers, so I asked an obstetrician-gynecologist who specializes in that population group about it. I said, "My God, are they all living near a nuclear reactor? Why are there so many pregnant women with malignant tumors? There have never been so many before."
And he responded, "Of course there have been! It's just that we used to terminate their pregnancies." But now the approach has changed. Now, malignant tumors are treated, and the women give birth. One of the last three such women I operated on recently wrote to me, overjoyed at bringing a beautiful baby into the world. When I was operating on her, her baby was in the womb, waving at me. I nearly passed out when I saw that. I was trembling during the operation, while the obstetricians were laughing.