The 2025 World Conference on Genitourinary Cancers (World GU) brought together leading experts to discuss critical advances in managing complex genitourinary malignancies, with particular emphasis on variant histologies and community oncology care optimization. Key discussions centered on specialized treatment approaches for challenging patient populations and strategies for implementing cutting-edge therapies in community-based settings.
Variant Histology Management Strategies
Prostate Cancer Variants
Experts highlighted specialized treatment strategies for prostate cancer patients with variant histologies, particularly those with small cell histology or neuroendocrine differentiation. The discussion explored how modalities such as androgen deprivation therapy, chemotherapy, and radiation may factor into the care of patients with prostate cancer harboring variant histologies, especially in the context of a community oncology setting.
Bradley G. Somer, MD, medical oncologist and president at West Cancer Center & Research Institute, participated in discussions about optimizing care for these challenging patient populations. The experts emphasized the importance of tailoring treatment approaches based on specific histological variants to maximize therapeutic efficacy.
Bladder Cancer Histological Variants
The conversation focused on methods for managing papillary, plasmacytoid, small cell, and other disease variants in the context of bladder cancer. Based on previously published data and prior clinical experience, experts discussed the appropriate circumstances for implementing regimens such as enfortumab vedotin-ejfv (Padcev) plus pembrolizumab (Keytruda) or other immunotherapy approaches depending on how a patient presents with bladder cancer.
The experts noted a newfound "embarrassment of riches and possibilities" regarding the development and approval of novel intravesical therapies, highlighting the expanding therapeutic landscape for bladder cancer management.
Kidney Cancer Histological Considerations
The group reviewed strategies for managing clear cell, papillary, and chromophobe variants in kidney cancer along with other disease histologies. The experts considered key factors for deciding on when to administer VEGF inhibitors and other tyrosine kinase inhibitor combinations based on the observed histology.
Community Oncology Care Enhancement
Risk Stratification and Surveillance
Sam S. Chang, MD, MBA, chief surgical officer and Urologic Oncology division chief at the Vanderbilt Ingram Cancer Center, highlighted strategies for risk stratifying disease based on previously published guidelines, noting the importance of surveillance depending on a patient's observed degree of risk. The experts discussed how factors such as Decipher Prostate scores, MRI scans, and prostate-specific antigen (PSA) levels may factor into the decision to surveil patients with prostate cancer.
Kidney Cancer Management Decisions
Regarding kidney cancer, the group spoke about strategies for deciding between monitoring patients or expediting intervention with modalities like nephrectomy or cryoablation. An observed mass of less than 2 cm, for example, represented a situation where surveillance could be optimal. The experts also detailed appropriate circumstances for offering immunotherapy and tyrosine kinase inhibitor (TKI)-based regimens upfront prior to surgery.
Multidisciplinary Collaboration
Jeff Yorio, MD, medical oncologist and Central Texas Research Site Leader for Texas Oncology and Sarah Cannon Research Institute (SCRI), emphasized the importance of multidisciplinary care coordination. The discussion highlighted how medical oncologists can best collaborate with urologists to monitor patients undergoing intravesical treatment, emphasizing improving systemic therapies and locally assessing the bladder more efficiently.
Clinical Implementation Insights
The conference discussions were led by Manojkumar Bupathi, MD, MS, executive cochair of the Genitourinary Cancer Research Executive Committee at SCRI and medical oncologist with Rocky Mountain Cancer Centers, and Benjamin Garmezy, MD, associate director of genitourinary research and executive cochair of the Genitourinary Cancer Research Executive Committee at SCRI.
The experts emphasized that successful implementation of these advanced treatment strategies in community oncology settings requires careful consideration of patient-specific factors, histological variants, and available resources. The discussions underscored the evolving landscape of genitourinary oncology and the importance of staying current with emerging therapeutic options to optimize patient outcomes across different practice settings.
