Updates on Genitourinary Cancers

Dear Colleagues,

There is an increasing incidence of genitourinary (GU) cancers. This will become a major healthcare issue in the future. A lot of research on advances in surgery, radiotherapy and systemic treatment has been performed in the past decade. While our healthcare providers are all so busy with clinical duties, we thought it would be a great idea to summarize and discuss the latest treatment techniques and challenge researchers with ideas for future studies. Take, for example, prostatectomy—the Da Vinci arm has shortened hospital stay with precise small operative portals, which, together with artificial intelligence, makes remote surgeries feasible, benefiting underserved communities.

As for radiotherapy, ultra-hypofractionated SBRT (or Stereotactic Body Radiotherapy) is an advanced form of external beam radiation that delivers highly precise, ablative doses of radiation to the prostate gland over a dramatically shortened course. Typically completed in just five or fewer outpatient sessions, SBRT offers a convenient and non-invasive treatment option for patients with localized prostate cancer. This technique leverages sophisticated image guidance (IGRT) to target the tumor with extreme accuracy, minimizing radiation exposure to surrounding healthy tissues like the bladder and rectum. The high biological effectiveness of the large, focused doses has been shown to provide excellent cancer control outcomes comparable to longer conventional radiotherapy courses or surgery. SBRT is a well-tolerated and increasingly employed standard-of-care treatment for eligible patients, combining high efficacy with significant quality-of-life benefits due to its brief duration.

For systemic treatments, androgen receptor pathway inhibitors (ARPIs) and systemic chemotherapy also have revolutionized treatments for prostate cancer. For instance, oligometastatic prostate cancer describes an intermediate disease state where the cancer has spread beyond the prostate gland, but only to a limited number of sites—typically five or fewer. This concept bridges the gap between localized, curable cancer and widespread, incurable metastatic disease. Common locations for these limited metastases include bones or distant lymph nodes.

The treatment paradigm for oligometastatic disease is evolving. Instead of systemic therapy alone, there is a growing focus on combining it with metastasis-directed therapy (MDT). This involves using highly precise, local treatments like Stereotactic Body Radiotherapy (SBRT) to ablate the visible metastases. The goal of this aggressive local approach is to eradicate all detectable sites of disease, potentially delaying further cancer progression, improving cancer control, and possibly prolonging survival. This strategy aims for prolonged disease-free intervals and an improved quality of life for patients.

We invite colleagues around the world to report their clinical experience with original articles or reviews. Clinical contributions on all genitourinary sites are welcome in this collection.

Prof. Dr. Patricia Tai
Guest Editor

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• oligometastatic
• prostate cancer
• metastasis-directed therapy
• tumor debulking
• systemic therapy
• cancer progression
• stereotactic body radiotherapy
• genitourinary cancer
• radiotherapy
• CyberKnife