The Local Effects of Systemic Therapies in Urological Oncology: A Systematic Review.

BACKGROUND: Systemic therapies can impact local disease progression in genitourinary malignancies, potentially reducing the necessity for extensive surgery. Understanding these effects is crucial for optimizing treatment approaches in urologic oncology. METHODS: Through PubMed and Scopus databases search up to May 2026, we identified studies focusing on surgical outcomes after systemic therapy in prostate, kidney, testicular, and bladder cancers. RESULTS: In prostate cancer (PC), neoadjuvant hormonal therapy improved margin status and organ confinement but did not enhance biochemical-free survival rates. Chemotherapy or immunotherapy provided no clinical benefit. In kidney cancer, tyrosine kinase inhibitors and immune checkpoint inhibitors reduced tumor diameter by 13.5%-35% but did not improve recurrence-free survival. Certain therapeutic combinations decreased vena cava thrombus length, lessening surgical complexity. Post-chemotherapy, testicular cancer specimens revealed viable tumors in 8.3%-25% of cases, teratomas in 18.2%-50.0%, and scar or in situ neoplasms in 31.1%-60.0% of specimens. In muscle-invasive bladder cancer, cisplatin-based chemotherapy resulted in a pathological complete response (pCR) in approximately one-third of patients, and the addition of immunotherapy or antibody-drug conjugates further improved pCR rates. Molecular markers such as circulating tumor DNA and urine tumor DNA are being investigated as potential markers for predicting pCRs. CONCLUSIONS: Current systemic therapies do not eliminate the need for radical orchiectomy, nephrectomy, or local treatment in PC. The ability to avoid radical surgery in bladder cancer is still investigational. Therefore, attempts to avoid local treatment in patients with genitourinary malignancies should be pursued within the framework of a clinical trial.