Professor Xinan Sheng, Chief Physician of the Department of Medical Oncology for Melanoma and Sarcoma / Urological Oncology at Peking University Cancer Hospital and Beijing GoBroad Hospital, shared his insights on the current status and innovative approaches in the management of urological tumors.
Urological Tumors: Current Status, Treatment, and Integrated Management
Urological tumors share some similarities with other tumors but also have unique characteristics. They generally include kidney cancer, bladder cancer, and prostate cancer. In China, urological tumors account for about 10% of all solid tumors. However, their incidence has been changing in recent years, especially with a rapid increase in prostate cancer cases. In contrast, in Western populations, urological tumors represent nearly 20% of all solid tumors, almost on par with lung cancer.
Despite these trends, the overall prognosis for urological tumors is relatively favorable. For example, the median survival time for advanced kidney cancer and advanced prostate cancer has now exceeded 5 years, and some advanced prostate cancer patients even achieve a median survival of 7 to 8 years. Moreover, with advances in surgical techniques, the cure rates for early-stage kidney and prostate cancers have significantly improved. Although bladder cancer tends to recur, its 5-year survival rate remains among the highest for solid tumors, indicating an overall better prognosis.
Treatment patterns are also shifting from being surgery-dominated to a more comprehensive medical approach. In recent years, drug therapy for urological tumors has developed rapidly, especially in areas such as immunotherapy, anti-angiogenic targeted therapy, and immunotherapy combined with anti-angiogenic agents. For example, kidney cancer has pioneered the approach of combining immunotherapy with anti-angiogenic therapy; prostate cancer has seen major breakthroughs in endocrine therapy; and urothelial carcinoma of the bladder has driven the development of antibody-drug conjugates (ADCs) and immunotherapy combined with ADCs. These three major urological tumor types not only hold a unique position among solid tumors but also offer valuable lessons for systemic treatment strategies in other cancers.
Significant progress has also been made in early detection and treatment. For instance, early-stage kidney cancer diagnosis has evolved from being symptom-based to primarily incidental findings through simple ultrasound examinations, with tumor sizes shifting from 5–7 cm down to 2–3 cm. This has greatly improved treatment outcomes and advanced the diagnostic threshold. Additionally, prostate cancer benefits from reliable screening biomarkers that enable early detection. Therefore, urological tumors have unique advantages in early detection and treatment, offering insights for the management of other solid tumors.
Integrated care models are also evolving, with multidisciplinary collaboration becoming an essential component of cancer treatment. Take prostate cancer as an example—it requires the involvement of multiple specialties and diverse treatment modalities. Currently, all available anti-cancer strategies, including surgery, radiotherapy, chemotherapy, radionuclide therapy, and targeted therapy, are applied to prostate cancer with remarkable efficacy. Prostate cancer remains the only tumor type that encompasses all anti-cancer approaches. Given that most prostate cancer patients are elderly, the involvement of supporting specialties is even more crucial. Consequently, prostate cancer represents the paradigm of comprehensive cancer care, highlighting the importance of integrated treatment.
Breaking Collaboration Barriers to Improve Quality of Life for Urological Cancer Patients
Urological cancers involve multiple cutting-edge treatment modalities, including radionuclide therapy, ADCs, and targeted therapy. While these therapies bring new hope, they also introduce previously underrecognized adverse drug reactions. Therefore, balancing complications, drug toxicities, and expected therapeutic benefits has become a key priority.
Managing underlying conditions is particularly complex in urological cancer care, with blood pressure control being a typical challenge. This issue is especially pronounced in prostate cancer treatment, as these patients are usually older and frequently have cardiovascular comorbidities. The use of anti-angiogenic drugs can further raise blood pressure, increasing cardiovascular risks. Moreover, both anti-angiogenic and endocrine therapies can induce additional cardiovascular side effects. Many elderly patients also face problems like poor bone marrow reserve, hematologic disorders, and endocrine imbalances.
Similar multifactorial health challenges are common in other urological cancers and can be even more severe. For example, bladder cancer patients generally have the poorest baseline health among the three major urological cancers. These patients are typically older, more frail, and less tolerant of intensive treatment compared to kidney or prostate cancer patients.
Unfortunately, current multidisciplinary collaboration mechanisms are insufficient to address these complex challenges. Although onco-cardiology has grown rapidly in recent years, its integration into oncology remains limited, and communication between oncology and cardiology teams is often inadequate. Supporting departments such as cardiology, respiratory medicine, and endocrinology tend to respond slowly to complications and comorbidity management caused by new anti-cancer drugs, forcing oncologists to take the lead despite their limited expertise in managing such conditions. Cross-disciplinary communication and research remain insufficient. As a result, managing comorbidities and adverse effects in urological cancer care exposes systemic challenges faced across the oncology field.
With the continuous emergence of new treatment modalities, supporting departments have not kept pace in managing related complications. Consequently, despite therapeutic advances, gaps in comorbidity management can compromise treatment efficacy, delay care, and negatively impact long-term quality of life. As survival outcomes for urological cancer patients improve and life expectancy extends, the demand for multidisciplinary support—particularly from cardiology, endocrinology, and related specialties—has become more urgent than ever. However, these key supporting disciplines remain underrepresented in multidisciplinary cancer care models. To truly meet the comprehensive health needs of patients and ensure holistic treatment success, deeper involvement of supportive specialties in cancer care is essential, along with a more integrated framework for interdisciplinary collaboration.
From Traditional Radionuclides to Targeted Ligands: Innovation and Barriers in Prostate Cancer Therapy
Radionuclide therapy has long played a role in solid tumor treatment, though not as prominently as the recent surge in radioligand therapy. Previously, radionuclide therapy was mainly limited to Ra-223 for bone metastases and I-131 for thyroid cancer, both of which had clear limitations. Radioligand therapy, which combines targeting and radiation delivery, has rapidly advanced in prostate cancer treatment in recent years, significantly improving outcomes for castration-resistant prostate cancer. This targeted delivery concept is now being explored in other cancers as well.
In China, radioligand therapy is still an emerging field and faces policy-related hurdles. However, as clinical research on radiopharmaceuticals progresses domestically, barriers such as regulatory constraints, patient acceptance, and institutional readiness are expected to gradually diminish. Large medical and nuclear medicine centers are anticipated to drive the rapid development of this innovative therapy, accelerating its integration into cancer care.
