Urology in the twenty-first century: Noninvasive targeted treatments for urologic malignancies

Notwithstanding the major advances that have been made in the treatment of bladder cancer, prostate cancer, and kidney cancer, much remains to be done if we are to translate the gains that have been made in 'disease-free survival' into actual survival in terms of quantity as well as quality of life. Indeed, we are still at an embryonic stage in understanding how cancers originate, whether defense mechanisms exist that can recognize these cancers and recognize them when they first develop, when cancers metastasize during their development, whether we have methods that are sufficiently accurate to distinguish between organ-confined and regional extension or spread of disease, and the means by which we can identify cancers that are likely to remain organ-confined and distinguish them from those that are predestined to metastasize. If we are to be successful in the assessment and treatment of various urologic cancers, these questions must be answered. Many new methods of assessment and treatment are being explored that in themselves may provide some answers. The present discussion focuses on these issues, on how they may lead to further understanding of the unique biology of many of these tumors, and what we may expect in terms of increased longevity and improved quality of life as we attempt to cure patients of their disease.