Genitourinary Cancer
Genitourinary oncology covers the prostate, bladder, kidney, testis and penis — diseases whose biology and treatment logic differ so markedly that they are best considered individually.
Disease categories
Major disease categories
- Prostate cancer
- Bladder and urothelial cancer
- Kidney cancer
- Testicular cancer
- Penile cancer
Molecular
Molecular considerations
DNA damage repair alterations in prostate cancer, FGFR3 in urothelial cancer, and VHL and MET in renal cell carcinoma are among the most discussed site-specific features.
Markers commonly discussed in genitourinary cancer
- BRCA1/2 and HRR genes
- FGFR3
- VHL
- MET
- PD-L1
- MMR / MSI
Not exhaustive, and not every marker is assessed in every patient. Which of these is relevant depends on the individual case and should be discussed with the treating team.
Testing
Genomic testing considerations
Site-directed profiling, with germline assessment prominent in prostate cancer.
Germline
Germline considerations
Germline testing is widely discussed in metastatic prostate cancer and in selected renal and upper tract urothelial presentations.
Molecular monitoring
ctDNA and liquid biopsy considerations
Under study across the group, with particular interest in prostate and urothelial cancer.
Single-cell & computation
Single-cell and algorithmic approaches
Single-cell sequencing in genitourinary cancer is used to characterise lineage plasticity — particularly the transition towards neuroendocrine phenotype, which is a cell-state change that bulk profiling can miss entirely. Single-cell DNA analysis addresses clonal structure across metastatic sites, which is frequently discordant. Algorithm work includes DNA damage repair pathway scoring, resistance-alteration detection from serial plasma, and models that integrate imaging and molecular trajectories.
Decisions
Treatment decision questions
Questions worth raising with a treating team when a decision is being made:
- Is the primary site and histology precisely established?
- Has site-appropriate molecular testing been performed?
Resistance
Resistance and recurrence questions
- Has the molecular profile been reassessed after progression?
Trials
Clinical trial considerations
Site and molecular status shape eligibility.
When a precision oncology review may help
A review is most useful where the standard pathway has been exhausted or where the picture is more complicated than a protocol accounts for — rare presentations, treatment resistance, complex or apparently contradictory molecular findings, or a decision between several defensible options.
The output is a structured analysis and a set of questions for the treating team. It is not treatment, and it does not replace the treating oncologist.