Statement of Need

Genitourinary (GU) cancer refers to abnormal cell growth leading to the formation of tumors in the genital and/or urinary organs. Most genitourinary cancers occur in the prostate (in men), kidneys, or bladder. The American Cancer Society’s 2009 report estimates that 37%, or approximately 283,468 of the estimated 766,130 cases of cancer in men diagnosed in the US will involve a type of genitourinary cancer. Among cancer deaths in men, genitourinary cancers will account for nearly 20% (55,582) of the expected 292,540 deaths. This activity will review both the need for improved tumor markers to diagnose and prevent GU cancers, and ongoing research in treatment models for the various types GU cancers.

In genitourinary cancer, tumor markers are widely used for diagnosis, prognosis, evaluation of response to therapy, and early detection of recurrence. The levels of these tumor markers are used in addition to the standard TNM American Joint Committee on Cancer (AJCC) classification system to determine the stage of the disease, assess prognosis and guide treatment decisions. Despite their frequent use in diagnosis and prediction, none of the currently used tumor markers are perfect. Elevated AFP levels are not specific to testicular cancer and can indicate either malignant or benign liver disease. Similarly, although prostate-specific antigen (PSA) is highly specific to the prostate gland, elevated PSA is not specific to prostate cancer, and can result from benign prostatic disease. Indeed, only about 25% of men with an elevated PSA have biopsy detectable prostate cancer, resulting in an estimated 750,000 unnecessary biopsies in US men each year. On the other hand, some have argued that PSA is insufficiently sensitive, as many men with low PSA nonetheless have prostate cancer on biopsy: in the Prostate Cancer Prevention Trial (PCPT), where men were biopsied irrespective of PSA level, more than 11% of men with a PSA less than 1 ng/mL were found to have prostate cancer on biopsy. The suboptimal performance of many current markers, and the lack of proven markers for many urologic applications, such as the surveillance of bladder cancer or the detection and diagnosis of kidney cancer, has led to an intensive search for new markers. An estimated 4,000 papers published each year are on cancer-related markers. Yet despite such intense research activity, relatively few molecular markers have been successfully integrated into clinical practice. One possible reason why research on markers has yet to be translated to the clinic is that marker research has not had a clear goal. Evidence is needed that measuring the marker would change the decision a doctor would have made in the absence of the marker, and that this changed decision will benefit the patient. In addition to a needed review of markers, treatment options are evaluated and recent clinical trials reviewed at professional society meetings. Several important abstracts on genitourinary cancers were presented at the 2009 Genitourinary Cancers Symposium, a multi-disciplinary meeting held on an annual basis jointly sponsored by the American Society of Clinical Oncology (ASCO), Society for Urologic Oncology (SUO), and the American Society for Therapeutic Radiology and Oncology (ASTRO). The importance of peer review and presentation of clinical data is an important factor in physician education, and to ultimately determining proper courses of action in patient treatment. Among the more notable GU cancer abstracts reviewed were the Selenium and Vitamin E Cancer Prevention Trial (SELECT), 2 studies from the Department of Defense (DOD) Prostate Cancer Trials Consortium, results from the Vienna Testicular Tumor Study Group, and RECORD-1 Trial (REnal Cell cancer treatment with Oral RAD001) in renal cell carcinoma. In conclusion, ASCO GU 2009 had a substantial amount of new and important data presented regarding management of genitourinary cancer patients. While full presentation of these important data in peer review publications will be eagerly anticipated, this activity offers a peer review to provide participants with important information on treating GU cancers.

Target Audience

This publication is intended for urologists, oncologists, and other medical professionals involved in screening for, diagnosing and treating genitourinary cancers.

 Download a PDF of the full issue