From October 19 to 31, 2026, experts in GU Oncology shared new findings and perspectives across prostate cancer, bladder cancer, and renal cell carcinoma. Discussions covered clinical trials presented at ESMO 2026, recently published studies, biomarker research, and evolving treatment strategies.
This edition features an analysis from the PROpel trial evaluating olaparib plus abiraterone in metastatic castration-resistant prostate cancer with single homologous recombination repair gene mutations, real-world data comparing ICI–ICI and ICI–TKI combinations in sarcomatoid metastatic renal cell carcinoma, and findings from GDFatherNeo investigating neoadjuvant visugromab plus nivolumab in muscle-invasive bladder cancer (MIBC). Other topics include indirect comparisons of perioperative treatment strategies in MIBC and results from the PE-PE trial evaluating pembrolizumab combined with metastasis-directed therapy in oligometastatic renal cell carcinoma.
The selection also covers the FDA approval of talazoparib plus enzalutamide based on TALAPRO-3, findings from the PROTEUS substudy evaluating perioperative apalutamide plus androgen deprivation therapy in high-risk prostate cancer, and efficacy and safety outcomes from the phase 3 VOLGA trial in MIBC. Additional discussions focus on the APCCC consensus statement on early prostate cancer and a TALAPRO-2 biomarker analysis exploring the prognostic value ofcirculating tumor DNA and its early dynamics.
Together, these 10 posts offer a closer look at recent developments in GU oncology, including treatment intensification, perioperative approaches, immunotherapy combinations, and the growing role of biomarkers in understanding disease outcomes and informing clinical decisions.
Neal Shore — Medical Director, CPI, Carolina Urologic Research Center; Director, START GU Oncology Center of Excellence | United States
“Efficacy of Olaparib Plus Abiraterone for Patients with Metastatic Castration-resistant Prostate Cancer and Single Homologous Recombination Repair Gene Mutations in PROpel”
Sara Elena Rebuzzi — Medical Oncologist; PhD in Translational Oncology | Italy
“Sarcomatoid mRCC: ICI–ICI or ICI–TKI?
Meet-URO 33 Real-world data: ICI–ICI looked better on OS (HR 0.58), but the gap faded after adjusting for baseline risk. Patient & disease features matter as much as the regimen.”
Andrea Necchi, MD, FASCO — Director, Strategic Program of Research in Genitourinary Tumors | Italy
“With GDFatherNeo ESMO26 We brought visugromab+nivo combination neoadjuvantly in pts with MIBC after the initial phase 1 data in refractory setting.
33% CR rates vs 8% Nivo+placebo
All pCR pts still event-free (median FUP 15.7m)
Only 1 relapse event in major responders in N+V arm (pTa relapse)
4/5 pCR skipped RC in N+V arm.
Safety was quite good.
Pre-existing CD8+ infiltration associated with N+V Response.
It was an illuminating academic-industry collaboration for me.
Results simultaneously released today in Nature Portfolio Nature Medicine”
José Daniel Subiela — Uro-Oncology and Urothelial Carcinoma; Robotic Surgery; Kidney Transplant Surgeon; Clinical Research, Hospital Ramón y Cajal and University of Alcalá | Spain
“Two people in the same working group spent a year answering the same question. Neither knew the other was doing it.
We found out late, when both projects were already well under way. The easy thing would have been to merge them and save everyone the trouble. We did the opposite. We let them run in parallel, each team with its own statistics, and agreed to live with whatever came out. If the two answers disagreed, we would have to say so.
Both papers are now published.
Brigida Anna Maiorano took the frequentist road, in ESMO Open, with EV-304, NIAGARA and KEYNOTE-905 (2,293 patients). Our team took the Bayesian one, in Urologic Oncology, with EV-304, NIAGARA and VESPER (2,364 patients).
Different statistics. Partly different trials. The same answer.
Against gemcitabine-cisplatin, enfortumab vedotin plus pembrolizumab improved event-free survival (HR 0.53) and overall survival (HR 0.65). Gemcitabine-cisplatin plus durvalumab improved both as well (HR 0.68 and 0.75). In both analyses, EV plus pembrolizumab ranked first across every endpoint.
What our study adds is the other half of the decision: toxicity. GC plus durvalumab produced no excess Grade 3 or higher toxicity over GC alone (41% vs 41%), and the indirect comparisons between the experimental regimens were not significant for survival. So we report benefit-risk profiles, not a winner. The patient in front of you is not a ranking.
Here is what I keep from all this.
Reproducibility is not a sentence you write in a discussion section. It is what happens, or does not happen, when two teams work the same problem apart. This time it happened, and I will admit I did not take that for granted while we were waiting.
And the perioperative paradigm in muscle-invasive bladder cancer really has changed. But what we know today is a small fraction of what we will know in a few years, and the questions that matter most now are the ones no trial was designed to answer: who finishes the treatment, who reaches surgery, who keeps their bladder, and at what cost.
That is why we started DELIVER-MIBC, a real-world collaboration on perioperative treatment, with first results coming at the European and American urology congresses. If you would like your centre to join, write to me.”
Aadil Najeed, MBBS, MD — Radiation Oncology, India
“The PE-PE trial presented at ESMO 2026 provides promising results for patients with oligometastatic renal cell carcinoma (RCC).
In this phase II trial, adding pembrolizumab to metastasis-directed therapy (MDT), such as surgery or SABR, improved recurrence-free survival compared with MDT alone.
Median recurrence-free survival: 25.4 months vs 11 months
Risk of recurrence or relapse: reduced by 53% (HR 0.47; p=0.024)
However, an overall survival benefit has not yet been established.
Side effects were more frequent with pembrolizumab.
The key message: combining immunotherapy with local treatment may help patients remain disease-free for longer, but longer follow-up is needed to understand its impact on survival.An encouraging step towards integrating systemic and local treatments in oligometastatic RCC.”
Katy Beckermann, MD — Medical Director, GU Clinical Research, Tennessee Oncology; Chair, OneOncology GU Disease Group; Physician-Scientist | United States
“FDA approved talazoparib plus enzalutamide for metastatic prostate cancer with HRR gene mutations, in HSPC/APMN/APMS based on TALAPRO-3.
The phase 3 trial randomized patients with HRR-mutated disease to the combination or enzalutamide alone. Roughly 85% had de novo metastatic disease, and prior docetaxel was not allowed.
Combination vs enzalutamide alone: rPFS HR 0.48, 95% CI 0.36 to 0.65, with 36-month rPFS 77% vs 56%
BRCA1/2 HR 0.37 and non-BRCA HRR HR 0.57, post hoc, with wide intervals
Grade 3 or 4 events 79% vs 41%, anemia in 71%, discontinuation 19% vs 10%.
OS is immature, interim HR 0.77, 95% CI 0.56 to 1.04”
Prof. Dr. Axel S. Merseburger — Professor and Chair of Urology, University Hospital Schleswig-Holstein (UKSH), Lübeck; DGU/EAU Board Member; EUSP Chair | Germany
“Proud to share our latest work, now online in European Urology: the PROTEUS substudy.
The main PROTEUS trial compared perioperative apalutamide + ADT with ADT alone. One question remained: how does treatment intensification perform against today’s standard of care, radical prostatectomy alone?
In this open-label, randomized substudy, 408 patients with high-risk localized or locally advanced prostate cancer were randomized 1:3:
EFS: HR 0.38 (95% CI 0.26–0.55); 3-yr EFS 63% vs 41%
RMST at 36 mo: +11.0 months event-free time
MFS by PSMA PET or conventional imaging: HR 0.49; 3-yr 87% vs 78%
Time to first subsequent therapy: HR 0.29; at 3 yr, 35% vs 68% needed further treatment
Positive surgical margins: 17% vs 56%
Equally important, and part of an honest reading:MFS by conventional imaging does not differ yet (HR 0.74; 94% vs 92%)
OS is immature, and PSMA-PET-based MFS is not a validated surrogate
Grade 3–4 TEAEs occurred in 31% vs 22%, with 12 months of ADT-related toxicity to weigh
My take: this supports perioperative intensification as an option for carefully selected, surgery-fit high-risk patients. Shared decision-making and better biomarker-based selection remain key.”
Enrique Grande — Medical Oncologist; Director, One Oncology Madrid Cancer Program, Quirónsalud | Spain
“Can we achieve better outcomes for patients with muscle-invasive bladder cancer while reducing the burden of treatment?
The phase 3 VOLGA trial, presented by Tom Powles at the ESMO – European Society for Medical Oncology Presidential Symposium and now published in NEJM Group, brings us an important step closer to answering this question.
I feel truly honoured to have contributed to this international effort as a member of the study’s steering committee and as second author, working alongside Tom and an outstanding group of colleagues from around the world including my feiend.
VOLGA included 695 patients with MIBC who were unable to receive, or had declined, cisplatin-based chemotherapy. The study evaluated treatment before and after bladder surgery.
In the durvalumab plus enfortumab vedotin group, compared with surgery alone:
Event-free survival at two years was 63.5% versus 45.1%. This measure captures whether patients remained alive without the cancer returning, progressing or another event defined in the study.
Overall survival at two years was 78.4% versus 69.4%.
Adding tremelimumab to the combination also improved EFS compared with surgery alone, although OS had not reached statistical significance at this interim analysis.
Side effects remain an important consideration. Severe adverse events from any cause occurred in 71.1% of patients receiving durvalumab plus EV and 50.2% in the surgery-alone group.
For me, one of the most meaningful aspects of VOLGA is its treatment design: EV was given for 3 cycles before surgery, with no further EV after surgery, while immunotherapy continued after the operation.A shorter course of this drug may help reduce treatment exposure and the number of visits needed to receive it. Patient-reported quality of life was maintained after surgery in the durvalumab plus EV group. VOLGA did not directly compare this schedule with longer EV regimens, so we cannot conclude that it causes fewer side effects or leads to better quality of life than those approaches.
Progress in oncology must be measured not only by how long our patients live, but also by how they live. Sometimes, less may be more: finding the right treatment, for the right patient, for the right amount of time.
My sincere thanks to Tom, the VOLGA investigators and research teams across the world, and especially to the patients and families whose participation made this study possible. Thank you to AstraZeneca, which funded the study, and to ESMO – European Society for Medical Oncology for providing a global platform to share these results.
It is a privilege to continue contributing from Spain, now through Quirónsalud and One Oncology Madrid Cancer Program, to international research that may improve the lives of people affected by bladder cancer.”
Tom Powles — Professor of Genitourinary Oncology, Barts Cancer Institute, Queen Mary University of London | United Kingdom
“Amazing APCCC prostate consensus statement out today on early prostate cancer. Experts from around the world come together in Lugano to address the most contravercial issues.”
Sara Coca Membribes — Medical Oncologist; GU Oncology Clinical Research Fellow, Barts Cancer Institute, Queen Mary University of London | United Kingdom
“New biomarker analysis from TALAPRO-2
Baseline ctDNA and early dynamics correlated with rPFS, adding prognostic value beyond PSA in some patients.
Integrating ctDNA, circulating tumour cells and PSA warrants further exploration.”
Find out 10 Must-Read Posts in GU Oncology from the October 12 to 18 on OncoDaily.
