Exercise as Medicine in Genitourinary Oncology: Prehabilitation, Rehabilitation, and Biological Mechanisms Driving Surgical and Oncologic Outcomes

Genitourinary (GU) cancers - prostate, bladder, renal cell carcinoma, upper tract urothelial carcinoma, testicular, and penile - represent one of the highest-burden cancer groups in the United States. Prostate cancer is the most commonly diagnosed non-skin malignancy in American men, while bladder cancer ranks among the most costly to manage per patient. Surgery is central to curative intent, and major procedures - radical prostatectomy, radical cystectomy, and nephrectomy - carry substantial perioperative demands and prolonged recovery trajectories. Patients frequently present in a deconditioned state, with compromised cardiorespiratory fitness, muscle wasting, and metabolic dysfunction that compound operative risk and impair quality of life.Evidence that structured exercise can modify surgical risk, accelerate recovery, and influence oncologic outcomes is growing rapidly. Prehabilitation - optimization of functional capacity between diagnosis and surgery - has shown promise in improving VO₂ peak, reducing postoperative complications, and supporting earlier recovery of continence and sexual function. Post-surgical rehabilitation has demonstrated benefit in reversing treatment-related sarcopenia, managing androgen deprivation therapy (ADT)-induced metabolic sequelae, and improving survivorship. Despite this, exercise remains underutilized in GU oncology and the biological mechanisms driving its effects remain incompletely understood.A rapidly expanding frontier concerns how exercise remodels the tumor microenvironment, modulates immune surveillance, and regulates myokine signaling - with circulating factors such as IL-6, irisin, and epinephrine implicated in NK cell trafficking and tumor vascularity. Advances in digital health platforms and wearable technology are opening avenues to scale prehabilitation equitably.This Research Topic invites contributions across the GU oncology care continuum - from preoperative optimization through post-treatment survivorship. We welcome original research, clinical trials, systematic reviews, mechanistic studies, perspective articles, and study protocols. Submissions bridging clinical and translational science and those addressing health equity and implementation in diverse populations are encouraged.Indicative topics include, but are not limited to:Prehabilitation before major GU surgery: impact on perioperative complications, length of stay, and functional recoveryCardiorespiratory fitness as a surgical risk modifier: VO₂ peak and fitness metrics as predictors of postoperative morbidityPost-surgical rehabilitation: recovery of continence, erectile function, and quality of life; pelvic floor rehabilitation within exercise oncology frameworksSarcopenia and body composition: resistance training and nutrition-exercise strategies to preserve muscle mass during and after treatmentBiological mechanisms: exercise-induced modulation of the tumor microenvironment, anti-tumor immunity, myokine signaling, and metabolic reprogrammingExercise during systemic therapy: ADT-induced sarcopenia and cardiovascular risk; exercise during immunotherapy or targeted therapy for renal cell carcinoma and urothelial carcinomaExercise dose, modality, and timing: aerobic training, resistance training, HIIT, and multimodal programs; optimal timing relative to surgery or systemic therapyDigital health and remote delivery: telehealth-based prehabilitation, wearable monitoring, and scalable delivery modelsFrailty and geriatric oncology: exercise to modify frailty in older adults; integration with geriatric assessmentHealth equity and implementation: disparities in access to prehabilitation; multidisciplinary care models and cost-effectiveness Topic editors: Sabine Doris Brookman-May, Melanie Keats Source: https://www.frontiersin.org/research-topics/85628/exercise-as-medicine-in-genitourinary-oncology-prehabilitation-rehabilitation-and-biological-mechanisms-driving-surgical-and-oncologic-outcomes