Precision Strategies in Genitourinary Oncology: Biomarkers, Treatment Sequencing, and Clinical Decision-Making

Genitourinary cancers, including renal cell carcinoma, prostate cancer, and urothelial carcinoma, represent a paradigmatic example of the evolving complexity of modern oncology. Historically, treatment strategies were largely linear and guideline-driven, with relatively limited therapeutic options. The introduction of immune checkpoint inhibitors, novel androgen receptor–targeted agents, targeted therapies, and antibody–drug conjugates has dramatically expanded the therapeutic armamentarium.While these advances have improved survival outcomes, they have also introduced significant uncertainty regarding optimal treatment sequencing and patient selection. Many pivotal trials compare new regimens against historical standards rather than against other contemporary options, leaving clinicians with multiple guideline-concordant strategies but limited prospective evidence to guide the optimal choice. Furthermore, predictive biomarkers capable of reliably guiding therapy selection remain insufficiently validated in routine clinical practice. As a result, treatment decisions increasingly rely on clinical judgment, patient characteristics, and evolving evidence from translational and real-world studies.The therapeutic landscape of genitourinary cancers has undergone profound transformation over the past decade. In metastatic renal cell carcinoma, metastatic hormone-sensitive prostate cancer, and advanced urothelial carcinoma, multiple evidence-based treatment options are now available in the same clinical setting. Immunotherapy combinations, targeted therapies, antibody–drug conjugates, and intensified hormonal strategies have significantly improved patient outcomes. However, the coexistence of several effective regimens has created a new clinical challenge: treatment selection is increasingly driven by strategic decision-making rather than by predefined therapeutic algorithms.In the absence of robust predictive biomarkers, clinicians must balance treatment intensity, toxicity, sequencing strategies, comorbidities, and patient preferences when selecting first-line therapy. This Research Topic aims to explore how emerging evidence, including translational biomarkers, real-world data, and innovative analytical approaches, can help refine treatment selection and sequencing in genitourinary oncology. By integrating clinical research with translational insights, this collection seeks to advance a more personalized and evidence-informed approach to therapeutic decision-making in urologic malignancies.This Research Topic aims to gather high-quality contributions addressing the challenges of therapeutic decision-making and treatment sequencing in genitourinary cancers. We welcome submissions that explore clinical, translational, and methodological aspects that may improve patient selection and optimize treatment strategies.Topics of interest include, but are not limited to:• Treatment sequencing strategies in renal cell carcinoma, prostate cancer, and urothelial carcinoma• Predictive and prognostic biomarkers for immunotherapy and targeted therapies• Molecular profiling and precision oncology approaches• Liquid biopsy and circulating biomarkers• Real-world evidence and outcomes research in genitourinary oncology• Response-adapted strategies and early treatment response markers• Artificial intelligence and clinical decision support systems• Emerging therapeutic approaches, including antibody–drug conjugates and novel immunotherapy combinationsWe welcome Original Research Articles, Reviews, Systematic Reviews, Mini-Reviews, Perspectives, and Clinical studies that provide new insights into therapeutic decision-making and personalized treatment strategies in genitourinary cancers. Manuscripts must be original, scientifically rigorous, and aligned with the scope of Frontiers in Medicine, Urological Disorders Section. Topic editors: Giandomenico Roviello, Linda Cerbone Source: https://www.frontiersin.org/research-topics/82361/precision-strategies-in-genitourinary-oncology-biomarkers-treatment-sequencing-and-clinical-decision-making