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Cancers
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Minimally Invasive Therapies in Urologic Cancers
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Minimally Invasive Therapies in Urologic Cancers

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Methods and Technologies Development".

Deadline for manuscript submissions: 15 August 2026 | Viewed by 5067

Special Issue Editors

Dr. Eric M. Walser

E-Mail Website
Guest Editor
Department of Radiology and Imaging, University of Texas Medical Branch at Galveston, 301 University Blvd., Galveston, TX 77555, USA
Interests: interventional radiology; MRI-guided laser ablation
Special Issues, Collections and Topics in MDPI journals
Dr. Guglielmo Manenti

E-Mail Website
Guest Editor
Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
Interests: imaging; ablation; prostate cancer; kidney cancer
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Surgery and radiation therapy are the traditional treatments for urologic cancers. However, recent technological and procedural advances promote minimally invasive techniques that can focally ablate a subset of organ-confined cancers, offering control similar to that of traditional, more invasive methods. Percutaneous or endoscopic techniques are increasing in variety as modern imaging enables the diagnosis of smaller and less aggressive urologic tumors. These lesions are often best treated with focal therapy, which offers fewer side effects and complications, along with excellent technical success and cancer control. Urologic cancers that are best treated with such techniques originate in the urothelium, adrenal gland, kidney and prostate. Additionally, recent advances in targeted PET scanning allow for new possibilities for percutaneous treatment in highly selected patients with oligometastatic disease.

This Special Issue focuses on interventional and imaging innovations that support minimally invasive techniques in the management of urologic cancers.

In this Special Issue, original research articles and reviews are welcome.

We look forward to receiving your contributions.

Dr. Eric M. Walser
Dr. Guglielmo Manenti
Guest Editors

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

  • laparoscopic surgery
  • robotic-assisted surgery
  • ablation
  • high-intensity focused ultrasound
  • partial nephrectomy
  • minimally invasive procedures
  • urologic cancers

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Published Papers (4 papers)

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Research

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10 pages, 719 KB  
Article
Robotic Vessel Sealer vs. Robotic Bipolar Grasper in Partial Nephrectomy
by Murad Asali, Osman Hallak and Galeb Asali
Cancers 2026, 18(5), 802; https://doi.org/10.3390/cancers18050802 - 2 Mar 2026
Viewed by 602
Abstract
Background: Robotic-assisted partial nephrectomy (RAPN) is widely used for nephron-sparing surgery. Vessel sealing technologies play a crucial role in these procedures, influencing ischemia time, blood loss, and surgical outcomes. This study compares the efficacy and safety of using a robotic vessel sealer (VS) [...] Read more.
Background: Robotic-assisted partial nephrectomy (RAPN) is widely used for nephron-sparing surgery. Vessel sealing technologies play a crucial role in these procedures, influencing ischemia time, blood loss, and surgical outcomes. This study compares the efficacy and safety of using a robotic vessel sealer (VS) versus conventional bipolar energy in robotic partial nephrectomy. Methods: A retrospective analysis was conducted on patients (n = 112) undergoing RAPN using either a robotic VS or bipolar energy grasper between 2023 and 2025. Parameters analyzed included ischemia time, estimated blood loss (EBL), postoperative complications, and functional outcomes. Statistical comparisons were performed to assess differences in perioperative and postoperative metrics. Results: The vessel sealer (VS) group (n = 54) had significantly lower blood loss (40 mL vs. 132.5 mL, p = 0.037) than the bipolar group (n = 58). Ischemia time was similar (24.5 min vs. 20.46 min, p = 0.444). No significant differences were found in operative time, console time, docking time, or postoperative complications (p > 0.05). The tumor diameter (CT: 28.38 mm vs. 25.5 mm, p = 0.655; pathology: 2.34 cm vs. 1.96 cm, p = 0.375) and Radius–Exophytic/Endophytic–Nearness to collecting system or sinus–Anterior/posterior–Location relative to polar lines (RENAL) score (7.00 vs. 6.17, p = 0.202) were slightly higher in the bipolar group but not statistically significant. Conclusions: Both techniques seem to be used for tumors of comparable size and complexity, suggesting no strong selection bias. Future research should prioritize randomized controlled trials assessing long-term renal function, cost-effectiveness, and potential refinements of robotic vessel sealing technology. A broader, multicenter analysis could provide further insight into optimal device selection for robotic partial nephrectomy. Full article
(This article belongs to the Special Issue Minimally Invasive Therapies in Urologic Cancers)
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14 pages, 2131 KB  
Article
Deferred Versus Upfront Cytoreductive Nephrectomy in MetaStatic Renal Cell Carcinoma: Comparative Survival Analysis in the Immunotherapy Era
by Tao Xu, Paerhati Tuerxun, Ning Liu, Chencheng Ji, Kunlun Zhao, Yiguan Qian, Abudukelimu Abudushataer, Yang Li, Xiaotian Jiang, Zhongli Xiong, Min Wang, Ruipeng Jia and Yu-Zheng Ge
Cancers 2025, 17(19), 3136; https://doi.org/10.3390/cancers17193136 - 26 Sep 2025
Viewed by 1609
Abstract
Background: The optimal timing of cytoreductive nephrectomy (CN) in metastatic renal cell carcinoma (mRCC) remains a subject of debate, particularly in the immunotherapy era. This study compares survival outcomes between deferred CN (dCN) and upfront CN (uCN) in mRCC patients receiving modern immunotherapy [...] Read more.
Background: The optimal timing of cytoreductive nephrectomy (CN) in metastatic renal cell carcinoma (mRCC) remains a subject of debate, particularly in the immunotherapy era. This study compares survival outcomes between deferred CN (dCN) and upfront CN (uCN) in mRCC patients receiving modern immunotherapy regimens in the real-world setting. Methods: We retrospectively analyzed the SEER database for mRCC patients diagnosed between 2016 and 2021 who underwent dCN or uCN. The primary endpoint was overall survival (OS), while the secondary endpoints were disease-specific survival (DSS) and other-cause specific survival (OCSS). Statistical analyses included propensity score matching (PSM), Kaplan–Meier survival curves, Cox proportional hazards modeling, as well as sensitivity, subgroup, and landmark analyses. Results: A total of 1892 mRCC patients were included, with 346 patients (18.3%) undergoing dCN and 1546 patients (81.7%) receiving uCN. Patients in the uCN group were characterized with lower T stage (p < 0.001), while those in the dCN group exhibited a higher incidence of lymph node involvement (p = 0.02) and sarcomatoid dedifferentiation (p = 0.002). Following 1:2 PSM, dCN demonstrated significantly better OS and DSS, but comparable OCSS to uCN. The sensitivity and subgroup analyses suggested that dCN may substantially improve the prognosis of mRCC patients across conditions. The landmark analysis showed that the survival advantage of dCN diminished after two years of follow-up. Conclusions: dCN may be associated with improved survival outcomes compared to uCN in selected mRCC patients receiving immunotherapy, and careful patient selection for dCN or uCN is essential. Full article
(This article belongs to the Special Issue Minimally Invasive Therapies in Urologic Cancers)
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15 pages, 1085 KB  
Article
Echolaser Focal Treatment for Prostate Cancer Guided by Fiducial Marker Placement
by Timoleon Granitsas, Ioannis Anastassakis, Stamatios Brempos and Kyriakos Brempos
Cancers 2025, 17(10), 1707; https://doi.org/10.3390/cancers17101707 - 20 May 2025
Viewed by 1792
Abstract
Background: Focal therapy has emerged as a viable alternative to radical prostate cancer treatment, offering oncologic control while minimizing morbidity. EchoLaser focal laser ablation (FLA) is a minimally invasive technique that utilizes high-precision laser energy for tumor destruction. This study evaluated the [...] Read more.
Background: Focal therapy has emerged as a viable alternative to radical prostate cancer treatment, offering oncologic control while minimizing morbidity. EchoLaser focal laser ablation (FLA) is a minimally invasive technique that utilizes high-precision laser energy for tumor destruction. This study evaluated the oncologic outcomes, procedural efficiency, and safety of EchoLaser focal therapy, comparing fiducial-assisted (FM+) and non-fiducial (FM−) approaches. Methods: A retrospective cohort study was conducted at Athens Medical Center, Greece, including 50 patients with localized prostate cancer treated with EchoLaser therapy. Patients were categorized into FM+ (n = 31) and FM− (n = 19) groups. Oncologic control (MRI and PSA levels at six months), procedural efficiency (operative time), and safety (adverse events) were assessed. Results: At six months, 80% of patients (n = 40) had no residual disease on MRI, while 20% (n = 10) showed persistent or recurrent tumor activity. PSA levels declined from 10.26 ± 14.99 ng/mL to 2.70 ± 2.67 ng/mL, reflecting a 74% median reduction. Procedure time was shorter in FM+ patients (33.48 ± 2.41 min vs. 45.79 ± 2.92 min, p < 0.01). Adverse events occurred only in the FM− group, including one case of urinary retention. Conclusions: FLA with EchoLaser using fiducial marker enhances procedural efficiency and could have a positive impact on oncologic control. These findings suggest that fiducial markers should be integrated into focal therapy protocols. Longer follow-up studies are needed to confirm the long-term outcomes. Full article
(This article belongs to the Special Issue Minimally Invasive Therapies in Urologic Cancers)
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Review

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18 pages, 886 KB  
Review
Focal Therapy for Prostate Cancer: State of the Art, Physical Principles, Potentials, and Challenges
by Luca Orecchia, Simone Steffani, Andrea Micillo, Roberto Miano, Eric Walser and Guglielmo Manenti
Cancers 2026, 18(10), 1523; https://doi.org/10.3390/cancers18101523 - 9 May 2026
Cited by 1 | Viewed by 563
Abstract
Background: The management of localized prostate cancer (PCa) suffers from the dilemma between the overtreatment associated with radical surgery and the uncertainty of active surveillance, highlighting a significant therapeutic gap specifically for intermediate-risk patients and selected low-risk patients. Focal therapy (FT) emerges as [...] Read more.
Background: The management of localized prostate cancer (PCa) suffers from the dilemma between the overtreatment associated with radical surgery and the uncertainty of active surveillance, highlighting a significant therapeutic gap specifically for intermediate-risk patients and selected low-risk patients. Focal therapy (FT) emerges as an advanced technological solution to balance rigorous oncological control with anatomical and functional preservation. Methods: A narrative review of the literature was conducted to analyze the physical principles underlying various ablative energies (thermal, cryogenic, and non-thermal) as well as radiation-based focal approaches. The review examines the oncological rationale of targeted ablation, recent innovations in imaging, and the expanding clinical scenarios for FT application. Results: Evidence supports the oncological rationale of “Index Lesion” ablation as a targeted curative strategy for clinically significant disease, rather than merely a palliative one. The review highlights the emerging concept of “pushing the disease” and demonstrates the valuable role of salvage focal therapy in the setting of radio-recurrent carcinoma. Furthermore, recent innovations in multiparametric magnetic resonance imaging (mpMRI) and fusion systems have significantly refined patient selection, rendering this minimally invasive approach highly targeted. Conclusions: The current barrier to the universal adoption of focal therapy is the lack of a standardized consensus on the definitions of therapeutic failure and the inadequacy of traditional PSA-based criteria. However, evidence suggests that FT represents a promising, organ-sparing alternative for carefully selected patients with localized PCa, though long-term comparative data are still required. Full article
(This article belongs to the Special Issue Minimally Invasive Therapies in Urologic Cancers)
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