Biennial report on genitourinary cancers

The last 2 years (2014 and 2015) have witnessed major advances in the treatment of genitourinary malignancies. Of note and in marked contrast to previous years, all four major cancers (prostate cancer, testicular cancer, kidney cancer, and bladder cancer) have benefited from this progress. In prostate cancer, it was clearly demonstrated that a local treatment should be administered for high-risk localised disease. The standard of care was changed for patients with upfront metastatic disease with combined androgen deprivation therapy plus docetaxel becoming the new standard for fit patients with multiple bony metastases. In castrate-resistant disease, AR-V7 variants were shown to be predictive factors for resistance to next-generation AR axis-targeting agents and DNA repair targeting emerged as a promising new strategy. In poor-prognosis advanced non-seminoma, a better outcome was randomly demonstrated for the first time when a switch-intensified treatment was used in patients with a slow tumour marker decline. In metastatic kidney cancer, both cabozantinib and checkpoint inhibitors (nivolumab) are now associated with improved outcomes in pretreated patients and should soon change the standard of care for these patients. Last but not least, in urothelial bladder cancer, molecular classification is evolving and suggesting that immunotherapy with checkpoint inhibitors is active, as demonstrated in early trials.