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Genitourinary Tumors and Radiation Therapy: Current Advances and Future Directions
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Genitourinary Tumors and Radiation Therapy: Current Advances and Future Directions

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Nuclear Medicine & Radiology".

Deadline for manuscript submissions: 20 October 2026 | Viewed by 2748

Editor

Dr. Shalini Moningi

E-Mail Website
Guest Editor
Department of Radiation Oncology, Cleveland Clinic Foundation, Cleveland, OH, USA
Interests: prostate cancer; bladder cancer; kidney cancer

Special Issue Information

Dear Colleagues,

As we all know, radiation treatment has a vital role in the treatment of prostate, bladder, and kidney cancers. However, radiation treatment can also be associated with short- and long-term toxicity. Most recently, the development and usage of biomarkers have helped improve personalization for the treatment of genitourinary diseases. The aim of this Special Issue is to present original clinical research that has helped improve outcomes and quality of life for patients with bladder, kidney, and/or prostate cancer. Specifically, we are considering research topics focused on clinical outcomes, both prospective trials and retrospective reviews, as well as meta-analyses of large data and various relevant quality of life topics. Additionally, we welcome any papers focusing on novel treatment techniques, such as adaptive radiotherapy, in the setting of treatment for GU cancers.

I look forward to receiving your contributions.

Dr. Shalini Moningi
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 short 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-anonymized peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine 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 2600 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

  • cancer
  • prostate cancer
  • bladder cancer
  • kidney cancer
  • radiation therapy

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Published Papers (4 papers)

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Research

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11 pages, 1436 KB  
Article
Medical Management of Modifiable Risks: Improving Survival in High-Risk Prostate Cancer Patients Receiving Brachytherapy
by Shalini Moningi, Grgur Mirić, Robert W. Galbreath, Ryan Fiano, Kent E. Wallner, Mutlay Sayan, Peter F. Orio and Martin King
J. Clin. Med. 2026, 15(14), 5414; https://doi.org/10.3390/jcm15145414 - 10 Jul 2026
Viewed by 367
Abstract
Background: High-risk (HR) prostate cancer has a propensity for local and distant progression with ultimate death, mandating aggressive locoregional and systemic treatment approaches to maximize oncologic outcomes. Although brachytherapy (BT) with supplemental therapies has demonstrated favorable biochemical and quality of life outcomes, improvements [...] Read more.
Background: High-risk (HR) prostate cancer has a propensity for local and distant progression with ultimate death, mandating aggressive locoregional and systemic treatment approaches to maximize oncologic outcomes. Although brachytherapy (BT) with supplemental therapies has demonstrated favorable biochemical and quality of life outcomes, improvements in overall survival have been hampered by an excessive incidence of non- prostate cancer deaths. In this HR study, we report on biochemical failure (BF), prostate cancer-specific mortality (PCSM), overall mortality (OM) and patterns of death with recommendations for the mitigation of non-prostate cancer deaths. Materials and Methods: From April 1995 to November 2018, 577 consecutive HR patients were treated with LDR BT (97.9% Pd-103). Patients were stratified into three age cohorts: ≤ 59, 60–69 and ≥70 years. The BT prescription dose was prescribed to the prostate gland with generous peri-prostatic margins and the proximal 10mm of the seminal vesicles. 94.6% received supplemental EBRT (45–50.4 Gy) and 63.3% received androgen deprivation therapy (ADT) (median duration 12 months). Post-implant CT-based dosimetry was performed on day 0. BF was defined as a PSA > 0.40 ng/mL after nadir. The cause of death was determined for each patient. Patients with metastatic prostate cancer or non-metastatic castrate resistant prostate cancer who died of any cause were classified as dead of prostate cancer. All other deaths were attributed to the immediate cause. Multiple clinical, pathologic and treatment were evaluated for impact on patient outcomes. Results: Of the patients, 87.5% (median follow-up 8.9 years) presented with a single HR factor. The day 0 D90 was 122.5%. Overall, the 15-year BF, PCSM and OM were 12.4%, 5.6% and 51.7%. When stratified by age, there was no significant difference in BF or PCSM. The median post- treatment PSA in biochemically controlled patients was <0.01 ng/mL. In all three cohorts, OM increased linearly for the first 10 years and then approximately doubled from years 10 to 15. Moreover, 239 patients died: 10.9% due to prostate cancer, 38.1% from cardiovascular (CV) disease and 28.4% from other malignancies (to include one rectal and three bladder cancers). In MVA, BF was most closely related to percent positive biopsies (p < 0.001, SHR 1.018), PCSM to Gleason score (p = 0.004, SHR 2.884) and percent positive biopsies (p = 0.005, SHR 1.021) and OM to age (p < 0.001, HR 1.075) and tobacco (p < 0.001, HR 2.374). Conclusions: Despite high cancer control rates, overall survival was limited by a preponderance of CV and non-prostate cancer deaths, which were 6 times more likely than prostate cancer deaths. The implementation of a comprehensive multidisciplinary survivorship program will be essential to impact longevity in this patient population. Full article
(This article belongs to the Special Issue Genitourinary Tumors and Radiation Therapy: Current Advances and Future Directions)
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11 pages, 407 KB  
Article
Association Between Cribriform Architecture and Tertiary Gleason Pattern 5 in Prostate Cancer: A Cross-Sectional Study of Radical Prostatectomy Specimens
by Sayeh Fattahi, Yetkin Tuac, Okan Argun, Bryce Thomsen, Alicia C. Smart, Fallon E. Chipidza, Jonathan E. Leeman and Mutlay Sayan
J. Clin. Med. 2026, 15(12), 4637; https://doi.org/10.3390/jcm15124637 - 15 Jun 2026
Viewed by 484
Abstract
Background/Objectives: Cribriform architecture is an adverse Gleason pattern 4 morphology associated with aggressive prostate cancer outcomes. Tertiary Gleason pattern 5, even as a minor component, may also identify tumors with higher-grade biology not fully captured by conventional Grade Group assignment. We examined whether [...] Read more.
Background/Objectives: Cribriform architecture is an adverse Gleason pattern 4 morphology associated with aggressive prostate cancer outcomes. Tertiary Gleason pattern 5, even as a minor component, may also identify tumors with higher-grade biology not fully captured by conventional Grade Group assignment. We examined whether cribriform architecture is associated with tertiary Gleason pattern 5 in patients undergoing radical prostatectomy. Methods: We performed a retrospective cross-sectional study of radical prostatectomy specimens from patients with prostate adenocarcinoma who underwent radical prostatectomy and had available clinicopathologic data. A centralized pathology review of digitized radical prostatectomy slides was used to assess cribriform architecture. Tertiary Gleason pattern 5 status was obtained from original pathology reports. Multivariable logistic regression was used to evaluate the association between cribriform architecture and tertiary Gleason pattern 5 after adjustment for age, preoperative prostate-specific antigen level, prostatectomy Gleason score, pathologic tumor stage, and margin status. Results: Among 303 patients, 47 (15.5%) had tertiary Gleason pattern 5. Cribriform architecture was more common in tumors with tertiary Gleason pattern 5 than in those without (70% vs. 21%; p < 0.001). On multivariable analysis, cribriform architecture remained independently associated with tertiary Gleason pattern 5 (adjusted odds ratio of 9.46; 95% confidence interval of 4.49–21.0; p < 0.001). The model demonstrated good discrimination, with an area under the receiver operating characteristic curve of 0.80. Conclusions: Cribriform architecture was strongly associated with tertiary Gleason pattern 5. These findings suggest that cribriform-positive tumors may be more likely to harbor minor high-grade pattern 5 components. Full article
(This article belongs to the Special Issue Genitourinary Tumors and Radiation Therapy: Current Advances and Future Directions)
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11 pages, 747 KB  
Article
Association Between Cribriform Architecture and Lymphovascular Invasion in Prostate Cancer
by Jacqueline Chan, Yetkin Tuac, Okan Argun, Christina M. Breneman, Nora Seeley, Haley N. Moriarty, Keerthana Senthil Kumar, Fallon E. Chipidza, Jonathan E. Leeman and Mutlay Sayan
J. Clin. Med. 2026, 15(3), 1032; https://doi.org/10.3390/jcm15031032 - 28 Jan 2026
Cited by 2 | Viewed by 926
Abstract
Background/Objectives: Cribriform architecture is an adverse histopathologic feature in prostate cancer and has been associated with poor oncologic outcomes. Emerging evidence suggests that cribriform-positive tumors may behave as a biologically non-localized disease, raising the possibility of early occult dissemination. Lymphovascular invasion (LVI) is [...] Read more.
Background/Objectives: Cribriform architecture is an adverse histopathologic feature in prostate cancer and has been associated with poor oncologic outcomes. Emerging evidence suggests that cribriform-positive tumors may behave as a biologically non-localized disease, raising the possibility of early occult dissemination. Lymphovascular invasion (LVI) is a key pathological marker of metastatic potential, but its relationship with cribriform architecture has not been evaluated. We examined the association between cribriform morphology and LVI to provide biological context for the aggressive clinical course of cribriform-positive prostate cancer. Methods: We performed a retrospective analysis of patients with prostate adenocarcinoma who underwent radical prostatectomy and had available clinicopathologic data. Cribriform architecture was determined by a centralized pathology review, and LVI status was obtained from original pathology reports. Unadjusted associations were evaluated using contingency tables. Multivariable logistic regression was used to assess whether cribriform architecture was independently associated with LVI after adjustments for Gleason score, tumor stage, and nodal status. Results: Among 338 patients, 28 (8.3%) had LVI and 123 (36.4%) had cribriform architecture. LVI was more common in cribriform-positive than cribriform-negative tumors (17.9% vs. 2.8%; p < 0.001), corresponding to a crude odds ratio (OR) of 7.6 (95% CI, 3.0–19.3). Cribriform architecture remained independently associated with LVI after adjustment (adjusted OR, 5.20; 95% CI, 2.12–1.40; p < 0.001). Conclusions: Cribriform architecture is strongly and independently associated with LVI, supporting a biological link between cribriform morphology and early metastatic dissemination. These findings support the design of prospective, biomarker-driven studies to evaluate treatment intensification strategies in this high-risk subgroup. Full article
(This article belongs to the Special Issue Genitourinary Tumors and Radiation Therapy: Current Advances and Future Directions)
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Review

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16 pages, 282 KB  
Review
Bladder Preservation Therapy in Muscle-Invasive Bladder Cancer: Current Evidence and Future Directions
by Patrick P. Carriere and Comron J. Hassanzadeh
J. Clin. Med. 2026, 15(13), 5101; https://doi.org/10.3390/jcm15135101 - 30 Jun 2026
Viewed by 577
Abstract
Bladder preservation has emerged as an established treatment option for selected patients with muscle-invasive bladder cancer (MIBC), offering durable oncologic control with the potential to maintain native bladder function and quality of life. Over the past several decades, prospective trials and large institutional [...] Read more.
Bladder preservation has emerged as an established treatment option for selected patients with muscle-invasive bladder cancer (MIBC), offering durable oncologic control with the potential to maintain native bladder function and quality of life. Over the past several decades, prospective trials and large institutional experiences have refined trimodality therapy (TMT)—maximal transurethral resection followed by definitive radiation therapy with concurrent radiosensitizing systemic therapy—and clarified principles of patient selection, treatment delivery, surveillance, and salvage. Randomized evidence supports combined-modality therapy as the backbone of bladder preservation, and contemporary comparative analyses suggest outcomes comparable to radical cystectomy in appropriately selected populations. This review synthesizes the clinical foundations of bladder preservation, including radiobiologic considerations, advances in radiation technique, and patterns of recurrence following TMT. We discuss outcomes in higher-risk populations, including locally advanced and node-positive disease, and examine the evolving integration of systemic therapies. The emergence of immune checkpoint inhibitors and antibody–drug conjugates in urothelial carcinoma has reshaped the systemic treatment landscape and raises important questions regarding patient selection, sequencing, and the potential expansion of organ-preserving strategies. Finally, we outline future directions—including response-adaptive approaches, advances in image-guided and adaptive radiotherapy, and ctDNA-enabled risk stratification—while emphasizing the need for prospective validation and multidisciplinary collaboration to refine and optimize bladder-preserving care. Full article
(This article belongs to the Special Issue Genitourinary Tumors and Radiation Therapy: Current Advances and Future Directions)
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