The changing landscape of urologic oncology: Initiating systemic therapies, interventional skills, and clinical trials

Abstract

Historically, the field of urology has spearheaded the advances in genitourinary oncology that changed the landscape of cancer treatment, perhaps best illustrated by the discovery and application of androgen ablation by Charles Huggins in the 1940s. The advances in urology over the past 2 decades have continued to blossom, most notably in the technical aspects of robotic, laparoscopic, and endoscopic management of urologic tumors. However, substantial advances have also been made by radiation oncologists, radiologists, pathologists, and medical oncologists, and these advances have mandated increased training and education in urology to facilitate the appropriate multidisciplinary management of our patients. Furthermore, it is anticipated that the proportion of elderly in our population will continue to grow as our medical field improves preventive care measures, cardiovascular health, and treatments for conditions such as diabetes and other malignancies. Together, the result of these advances will only increase the intellectual and manpower demands on urology, highlighting the need for specialty focus on urologic oncology. This seminar series will focus on selected topics from a Society of Urologic Oncology course titled “The changing landscape of urologic oncology: Initiating systemic therapies, interventional skills, and clinical trials.” Here, we will emphasize the role of the urologist in several burgeoning areas of current urologic oncology practice. First, the past 3 years have seen an unprecedented number of novel, FDAapproved systemic therapies, including new cytotoxic agents, immunotherapeutic modalities, and targeted hormonal therapeutics. Many of these agents can be administered with fewer side effects, sometimes delivered orally as opposed to intravenously. These drugs will increase our overall armamentarium, and we are charged with maintaining our knowledge base in the ever-changing pharmacologic milieu of urologic oncology. Second, we will address the necessity of incorporating research in our clinics and for all clinicians to promote clinical trials. Clinical trials allow the clinician to have firsthand experience with new treatment strategies, the opportunity for patients to avail themselves of therapeutics when approved standards of care are not sufficient, and the enrichment the urologic oncology subspecialty by allowing us to keep pace with our medical oncology colleagues who have successfully ingrained clinical trials as part of their culture of training and community practice. Third, the rapid adoption of minimally invasive techniques and interventions has penetrated not only urology, but also interventional radiology. In this seminar series, we will examine the state of cryoablation for small renal tumors as a model of technologic advances in urologic practice. Lastly, this series will incorporate an examination of the economic realities that underlie the current healthcare system and how this affects urologic oncology, our cancer patients, and their families. In summary, the major focus of research and educational initiatives must remain patient centric, specifically what is best for enhanced patient care. We believe that the future of urologic oncology does not simply lie in the understanding and procurement of the technical aspects of open, laparoscopic, and robotic surgery, but also in our abilities and capabilities to communicate effectively with our medical oncology, radiation oncology, pathology, and radiology colleagues. No longer can we be enamored by the gadgets and devices of the manipulative and technical arts, as now we must strive to improve our understanding of disease mechanisms, cancer biology, and emerging therapeutics. Through this process, we will embrace scientific change, provide the optimum and individualized care for our patients, and continue to ensure the vigor of urologic oncology.