Urologic Cancer Facts

Prostate Cancer (PCA)

Prostate cancer is the most common cancer in US men and a major driver of cancer-related mortality worldwide. Therapies for advanced prostate cancer have advanced in several regards over the past decade, leading to better outcomes for many patients with this disease.  These developments have included combination hormonal therapies, adding secondary hormonal agents such as abiraterone or enzalutamide to standard androgen deprivation therapy. There has been active therapeutic development in molecularly targeted approaches across all of oncology in recent year and this has now expanded to prostate cancer with the integrations of targeted agents such as PAPR Inhibitors into standard of care applications. 

There remain many areas of clinical need for therapeutic development in prostate cancer.   Prostate cancer led with the first-in-class approval of Sipuleucel-t, an autologous cellular immunotherapy; however, despite many investigations, the clinical role of immune checkpoint inhibitors has not been established.  Radiopharmaceuticals have made a significant impact on the care of advanced prostate cancer patients as a monotherapy approach and there are many questions on the integration of additional agents in this class and their use in combination.  As note, the personalized medicine approach to therapy in PCA is now in place with the approval of PARP inhibitors, but many additional therapies, capitalize in the generic features of PCA remain. 

Bladder Cancer

Bladder cancer is a common cancer, the fourth most common cancer in men, and less commonly diagnosed in women.   It is commonly characterized as early or non-muscle-invasive disease, muscle-invasive localized, and locally advanced/metastatic disease.  After several decades of very limited therapeutic development, there has been a renaissance in the availability of new therapies for all forms of bladder cancer. This has included the approval and use now of multiple checkpoint inhibitors, antibody-drug conjugates, and targeted therapy approaches.

There are many novel and emerging areas for therapeutic development in bladder cancer.   Compared to just a few years ago, there are now many ongoing clinical trial investigations in the field.   With the rapid development and approval of many therapies, there is a need to define optimal approaches including combination therapy, across the spectrum of bladder cancer. While most of the drug development of the last several years has focused on metastatic disease, there are now several agents in late stages of development for the treatment of localized disease.  The development of novel therapy including the use of agents active in the metastatic setting in those with localized disease represents an area of opportunity. 

Kidney Cancer

Fifteen years ago, IL-2 represented the only approved systemic therapy with a clear improvement in survival, although the toxicity was significant.  The medical treatment of kidney cancer has undergone a dramatic transformation over the last 15 years with over 10 newly approved agents and regimens.  The treatment Paradigm has progressed from a limited cytokine-based therapy options, to targeted tyrosine kinase and mTOR Inhibitors, and now to an emerging era of immunotherapy and combination approaches.

With all of these rapid therapeutic advances for kidney cancer, there are many unanswered clinical questions.    Determining the most effective and best tolerated agents to use in combination is a developing area of focus.   Identifying novel agents and new effective drug classes will be critical to continue to advance the field.   Dose intensification earlier in the disease course with new combination approaches also holds significant promise and warrants further investigation. In addition, non-clear cell kidney cancer histology has not been adequately included many of the larger transformative studies and the optimal approach for these patients also needs to be defined.