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Clinical Trials and Evolving Treatment Paradigms in Urologic Cancers

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A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Clinical Research of Cancer".

Deadline for manuscript submissions: 1 August 2026 | Viewed by 3371

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Special Issue Editor

Dr. Zin War Myint

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Guest Editor

Division of Medical Oncology, Department of Internal Medicine, Markey Cancer Center, University of Kentucky, Lexington, KY 40546, USA
Interests: prostate cancer; urological oncology

Special Issue Information

Dear Colleagues,

This Special Issue will highlight innovations in the design, execution, and interpretation of clinical research in urologic cancers, including prostate, bladder, kidney, and testicular malignancies. As therapeutic options expand and clinical management becomes more nuanced, staying current with trial data and evolving treatment strategies is critical for oncology practice.

We welcome submissions that contribute to a comprehensive understanding of clinical progress in urologic oncology—ranging from pivotal clinical trials, subgroup analyses, meta-analyses, and treatment sequencing strategies to reviews of emerging therapeutic approaches. The issue also invites contributions on new frontiers such as biomarker integration, patient selection strategies, and the potential clinical role of artificial intelligence and digital tools.

This collection aims to bring together a wide range of research that reflects the dynamic and multidisciplinary nature of modern urologic oncology, offering insights for clinicians, researchers, and policy makers involved in the care of patients with genitourinary malignancies.

Urologic cancers continue to represent a significant proportion of the global cancer burden. Rapid developments in systemic therapies, trial designs, and risk-adapted strategies are reshaping how these malignancies are managed across different disease stages. Clinicians are increasingly challenged to stay informed on evolving evidence while personalizing care based on individual patient and disease characteristics.

We are pleased to invite you to contribute to the Special Issue, “Clinical Trials and Evolving Treatment Paradigms in Urologic Cancers,” in Cancers. This issue aligns closely with the journal’s clinical and translational mission and seeks to provide a platform for original research and critical reviews that reflect the current and future direction of genitourinary oncology.

This Special Issue aims to feature timely, high-quality contributions that inform best practices and highlight emerging trends in urologic cancer treatment. The goal is to assemble a broad yet cohesive body of work that reflects innovation across disciplines.

In this Special Issue, original research articles and reviews are welcome. Research areas may include (but are not limited to) the following:

Clinical trials and study design in urologic cancers;
Systemic therapy advances (e.g., hormonal, immune, and targeted therapies);
Biomarkers and patient selection in clinical practice;
Meta-analyses and evidence syntheses;
Treatment sequencing and combination strategies;
Emerging use of AI and digital technologies in urology;
Patient-reported outcomes and quality of life measures;
Evolving standards of care and practice-changing data.

We look forward to receiving your contributions.

Dr. Zin War Myint
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

urologic cancers
clinical trials
prostate cancer
bladder cancer
kidney cancer
testicular cancer
systemic therapy
meta-analysis
biomarkers
oncology innovation

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Published Papers (4 papers)

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Research

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14 pages, 624 KB

Open AccessArticle

Survival Outcomes of First-Line Therapy in De Novo Metastatic Urothelial Carcinoma with Histologic Subtypes: A National Cancer Database Analysis

by Zin W. Myint, Feitong Lei, Emma Tay and Bin Huang

Cancers 2026, 18(6), 950; https://doi.org/10.3390/cancers18060950 - 14 Mar 2026

Viewed by 660

Abstract

Background: Urothelial carcinoma with histologic subtypes represent an aggressive and understudied population frequently excluded from prospective clinical trials. Evidence guiding optimal first-line systemic therapy in de novo metastatic disease with histologic subtypes remains limited. Method: Patients with de novo stage IV urothelial carcinoma with histologic subtypes diagnosed between 2016 and 2021 were identified from the National Cancer Database (NCDB). Eligible patients received first-line chemotherapy, immunotherapy, or concurrent chemoimmunotherapy (both modalities initiated within 30 days). Overall survival (OS) was compared across groups using Kaplan–Meier methods and compared using log-rank tests and multivariable Cox regression. Result: Among 800 patients, 596 (74.5%) received chemotherapy, 106 (13%) received immunotherapy, and 98 (12%) received concurrent chemoimmunotherapy. Survival differed significantly across treatment groups (log-rank p = 0.005). Concurrent chemoimmunotherapy was associated with longer OS compared with chemotherapy alone (HR 0.73, 95% CI 0.55–0.93) and immunotherapy monotherapy. Immunotherapy alone was associated with inferior survival compared with chemotherapy. Conclusions: In de novo metastatic urothelial carcinoma with histologic subtypes, concurrent chemoimmunotherapy and chemotherapy were associated with superior survival compared with immunotherapy monotherapy. These findings support the consideration of early combination-based strategies and highlight the need for prospective studies dedicated to this high-risk population. Full article

(This article belongs to the Special Issue Clinical Trials and Evolving Treatment Paradigms in Urologic Cancers)

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12 pages, 366 KB

Open AccessArticle

Robot-Assisted Radical Prostatectomy Beyond the Learning Curve: Does Prior Laparoscopic Experience Influence Surgical Outcomes?

by Alberto Zambudio-Munuera, Irene Millán-Ramos, Patricia Rodríguez-Parras, Francisco Gutiérrez-Tejero, María Teresa Melgarejo-Segura, Miguel Arrabal-Martin and Miguel Ángel Arrabal-Polo

Cancers 2026, 18(4), 548; https://doi.org/10.3390/cancers18040548 - 7 Feb 2026

Viewed by 663

Abstract

Background/Objectives: Robot-assisted radical prostatectomy (RARP) is widely used in contemporary prostate cancer surgery; however, surgeons enter robotic practice through heterogeneous training pathways. This study aimed to compare early oncological and functional outcomes after RARP between two experienced robotic surgeons with different surgical backgrounds after completion of the learning curve. Methods: We conducted a retrospective, consecutive, single-center study including patients undergoing RARP after completion of the learning curve (> 40 cases) by two experienced robotic surgeons with different surgical backgrounds. Baseline characteristics, perioperative variables, and early oncological and functional outcomes were compared between surgeons. Pentafecta achievement was assessed as an exploratory composite outcome. Appropriate non-parametric and categorical statistical tests were applied as appropriate. Results: Ninety-three patients were included (55 operated on by surgeon A and 38 by surgeon B). Preoperative clinical and pathological characteristics were largely comparable between groups, except for prostate volume. Median operative time was significantly shorter for surgeon A (70 vs. 120 min, p < 0.001). Postoperative morbidity was low, with no major complications and no differences in length of hospital stay. At 6 months, urinary continence and erectile function recovery rates were high and comparable between surgeons. Oncological outcomes, including positive surgical margin rates and biochemical recurrence, did not differ significantly, although recurrence events were infrequent and follow-up was limited. Overall pentafecta achievement was modest and similar between groups (23.6% vs. 21.1%, p = 0.77), with positive surgical margins emerging as the main limiting factor. Conclusions: In this exploratory post-learning curve analysis, early oncological and functional outcomes after RARP were similar between surgeons with different surgical backgrounds. These findings should be interpreted cautiously and considered hypothesis-generating. Full article

(This article belongs to the Special Issue Clinical Trials and Evolving Treatment Paradigms in Urologic Cancers)

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Review

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13 pages, 688 KB

Open AccessReview

Clinical Trials and Emerging Therapeutic Paradigms in Upper-Tract Urothelial Carcinoma

by Julian Chavarriaga and Jay D. Raman

Cancers 2026, 18(8), 1223; https://doi.org/10.3390/cancers18081223 - 13 Apr 2026

Viewed by 871

Abstract

Upper-tract urothelial carcinoma (UTUC) represents a biologically distinct and clinically challenging subset of urothelial malignancies, accounting for only 5–10% of urothelial cancers but carrying a disproportionately high risk of advanced disease and recurrence. Historically, management strategies for UTUC have been extrapolated from bladder cancer data, with limited prospective evidence specific to the upper urinary tract. However, recent years have witnessed an expanding number of UTUC-focused clinical trials that are reshaping treatment paradigms across localized, locally advanced, and metastatic disease states. This review examines the evolving landscape of clinical trials in UTUC, highlighting pivotal and ongoing studies that will inform contemporary management. We summarize evidence supporting perioperative systemic therapy, including neoadjuvant and adjuvant chemotherapy, and discuss the expanding role of immune checkpoint inhibitors in both perioperative and metastatic settings. Additionally, we review trials evaluating kidney-sparing approaches, intraluminal therapies, and novel drug-delivery platforms aimed at preserving renal function while maintaining oncologic control. Emerging trial designs incorporating molecular profiling, fibroblast growth factor receptor (FGFR)-targeted therapies, and biomarker-driven patient selection are also explored. Despite meaningful progress, significant gaps remain, including the underrepresentation of UTUC patients in large urothelial cancer trials, heterogeneity in risk stratification, and challenges in trial accrual for this rare disease. We conclude by outlining future directions for UTUC-specific clinical research, emphasizing the need for collaborative, multicenter trials, innovative endpoints, and integrated translational studies to further refine personalized treatment strategies. As the clinical trial ecosystem for UTUC continues to mature, these efforts hold promises for improving outcomes while balancing oncologic efficacy with renal preservation. Full article

(This article belongs to the Special Issue Clinical Trials and Evolving Treatment Paradigms in Urologic Cancers)

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15 pages, 273 KB

Open AccessReview

Using ctDNA to Inform Adjuvant Therapy for Urologic Malignancies

by Rajvi Goradia, Taylor Goodstein, Debasish Sundi, Akshay Sood, Shawn Dason and Eric A. Singer

Cancers 2026, 18(7), 1121; https://doi.org/10.3390/cancers18071121 - 31 Mar 2026

Viewed by 834

Abstract

Decisions regarding the use of adjuvant systemic therapy in genitourinary (GU) malignancies—including bladder, kidney, and prostate cancers—are currently driven by clinicopathologic risk factors, which incompletely capture individual risk of residual disease. Consequently, patient selection for adjuvant treatment remains imprecise, leading to both overtreatment of cancers unlikely to recur and undertreatment of those with occult residual disease. Circulating tumor DNA (ctDNA), a minimally invasive liquid biopsy biomarker for minimal residual disease, has emerged as a promising tool to refine adjuvant treatment decision-making. Detection of ctDNA reflects persistent tumor-derived genomic material and often precedes radiographic recurrence, whereas ctDNA negativity is consistently associated with favorable oncologic outcomes. In this review, we summarize the evolving evidence supporting the use of ctDNA to guide adjuvant therapy decisions in bladder, kidney, and prostate cancers. This is not a comprehensive review on all of the potential applications of ctDNA in these malignancies. Rather, we aim to highlight disease-specific, adjuvant-guiding applications, including post-neoadjuvant and post-cystectomy decision-making in bladder cancer and emerging proof-of-concept data in renal cell carcinoma, and explore the potential application of ctDNA in the post-prostatectomy setting. Collectively, these data suggest that ctDNA may enable a paradigm shift toward biologically informed escalation and de-escalation of adjuvant therapy across GU malignancies, while underscoring the need for prospective validation in biomarker-driven clinical trials. Full article

(This article belongs to the Special Issue Clinical Trials and Evolving Treatment Paradigms in Urologic Cancers)

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