In the third episode of Treating Together, medical oncologist Benjamin Garmezy, MD, and urologist Alexander Kenigsberg, MD, provide a multidisciplinary perspective on organ preservation strategies for genitourinary cancers.

Episode Highlights

1:26 | Active Surveillance in Prostate Cancer

4:59 | Genomic Classifiers in Prostate Cancer

7:11 | Focal Ablation Therapies for Prostate Cancer

11:42 | Bladder-Sparing Treatments for Urothelial Carcinoma

18:06 | Lower vs Upper Tract Urothelial Carcinoma

19:39 | Treatment in Renal Cell Carcinoma

22:13 | Tumor Size and Intervention in Renal Cell Carcinoma

24:39 | The Importance of Multidisciplinary Care

Starting with prostate cancer, they explore the nuances of active surveillance for low-risk and intermediate-risk patients. Kenigsberg notes the critical role of MRI in modern risk stratification, moving beyond traditional Gleason scores and prostate-specific antigen levels. The discussion also covers emerging focal ablation therapies.

Moving to urothelial carcinoma, the oncologists cover the morbidity of radical cystectomy and the growing landscape of bladder-sparing therapies. They review FDA-approved options for non–muscle invasive disease but caution that the optimal sequencing of these agents and their long-term impact on curing disease remain unanswered questions.

For renal cell carcinoma, they focus on tailoring management to preserve renal function, going into the roles of partial nephrectomy, ablation, and the increasingly recognized utility of radiation therapy for patients who are not surgical candidates.

“I think that [multidisciplinary care] is the direction this field is going, and I think that’s probably one of the bigger barriers to adoption because we all get busy in our own practices and we don’t always have the systems in place to bounce these ideas off of each other—these innovations off of each other. The patients coordinate patient care, and so I think that’s really critical,” says Kenigsberg.

Garmezy and Kenigsberg acknowledge the need for careful patient selection and candid discussions about organ preservation. Overall, the successful integration of these strategies into clinical practice hinges on collaboration between urology, medical oncology, and radiation oncology.