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Highlights from the 2025 European Association of Urology Annual Meeting
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| Low-Risk Recurrent NMIBC in the Elderly Patient – Fulguration as Day Care Protocol, Chemoablation in Mutated Tumors, and Active Surveillance Strategies with Urine Biomarkers
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| Marek Babjuk, MD, PhD, Antoni Vilaseca Cabo, MD, and Ashish Kamat, MD, MBBS
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| At EAU 2025, experts discussed organ-sparing approaches for managing low-risk, recurrent NMIBC in elderly patients. Dr. Babjuk advocated for in-office fulguration as a safe and effective alternative to TURBT, while Dr. Vilaseca highlighted chemoablation, particularly for FGFR-mutated tumors, citing promising response rates from trials like ATLAS and TAR-210.
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| Local Staging: Radiological Evaluation of MIBC with Bladder MRI
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| Martina Pecoraro, MD |
| Martina Pecoraro’s EAU 2025 presentation highlighted the role of MRI and the VI-RADS scoring system in staging muscle-invasive bladder cancer (MIBC). VI-RADS offers high accuracy in distinguishing NMIBC from MIBC and assessing extravesical disease, with strong inter-reader reliability. The BladderPath trial showed that an MRI-first approach reduced the time to correct treatment for MIBC by 45 days, supporting its integration into clinical pathways.
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| Localised MIBC: Evaluation of Complete Response Methods – Are We Ready to Spare? |
| Peter Black, MD |
| Peter Black’s EAU 2025 presentation explored the adequacy of current methods for assessing complete response in MIBC to support bladder-sparing strategies. Trials such as RETAIN and HCRN GU 16-257 have demonstrated promising outcomes, with clinical complete response rates leading to high metastasis-free survival and bladder preservation. |
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| Debate – Can We Avoid Radiation in the New Consolidation Treatment Landscape with Optimal Systemic Therapy? |
| Sima Porten, MD, MPH, Ananya Choudhury, MA (Cantab), PhD, MRCP, FRCR, and Paolo Gontero, MD |
| At EAU 2025, experts debated whether radiation is necessary in the consolidation treatment landscape for muscle-invasive bladder cancer patients achieving a clinical complete response after neoadjuvant chemotherapy. Dr. Sima Porten supported systemic therapy alone, emphasizing patient quality of life and the potential of surveillance, while Dr. Ananya Choudhury argued that radiation is essential to improving oncologic outcomes and reducing recurrence risk. |
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| The Role of Perioperative Neoadjuvant/Adjuvant Therapy in the Management of Bladder and Kidney Cancer
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| Philippe Spiess, BS, MS, MD, FRCS, FACS
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| Philippe Spiess' EAU 2025 lecture highlighted the expanding role of perioperative immunotherapy in bladder and kidney cancer, with trials like PURE-01 and NIAGARA demonstrating significant pathological complete responses in MIBC. While neoadjuvant and adjuvant immunotherapy show promise, current guidelines remain cautious, recommending their use primarily in clinical trials.
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| Imaging as a Biomarker |
| Valeria Panebianco, MD |
| Valeria Panebianco explored the role of imaging as a biomarker in urologic oncology, emphasizing the need for precision diagnostics to guide perioperative management. She highlighted key imaging biomarkers such as PI-RADS for prostate cancer, VI-RADS for bladder cancer, and emerging AI-driven tools that integrate imaging with omics data for improved risk stratification. |
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| Biomarker Discovery: From Bench to Bedside |
| Lars Dyrskjøt, PhD, MSc |
| Lars Dyrskjøt's EAU 2025 lecture focused on the critical role of biomarkers in urologic oncology, from discovery to clinical implementation. He highlighted the use of advanced technologies like genomics, proteomics, and AI to discover new biomarkers, emphasizing the importance of overcoming biological, technical, and regulatory challenges in their clinical validation. |
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| Bladder-Sparing Strategies: DNA Damage Response (DDR) Genes and Liquid Biopsies |
| Kent Mouw, MD, PhD |
| Kent Mouw's presentation at EAU 2025 focused on bladder-sparing strategies in muscle-invasive bladder cancer (MIBC) through the lens of DNA damage response (DDR) gene alterations and liquid biopsies. He highlighted promising research, including the RETAIN-1 trial, which is exploring how DDR gene status can help guide treatment decisions, potentially allowing certain patients to avoid radical cystectomy or trimodal therapy. |
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| Bladder Cancer: Role of ctDNA in Treatment De-Escalation |
| John Sfakianos, MD |
| John Sfakianos presented the potential of circulating tumor DNA (ctDNA) as a prognostic and predictive biomarker in bladder cancer, emphasizing its role in guiding treatment de-escalation. ctDNA analysis can help identify patients who may avoid neoadjuvant chemotherapy, predict recurrence-free survival, and refine follow-up strategies, potentially replacing imaging. He also discussed the DECIDE trial, which uses ctDNA to guide treatment decisions in muscle-invasive bladder cancer. |
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| Testis Cancer: Micro RNA |
| Robert J. Hamilton, MD, MPH |
| Robert Hamilton discussed the promising role of miR-371a-3p as a biomarker for testicular cancer, particularly for germ cell tumors. miR-371a-3p is highly sensitive, specific, and cost-effective, enabling non-invasive monitoring of tumor size, stage, and treatment response. Its utility spans various clinical scenarios, such as detecting small testicular masses, guiding decisions before primary and post-chemotherapy retroperitoneal lymph node dissection, and improving relapse detection. |
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| Kidney: PDL1 Expression, VHL Mutations, KIM-1 |
| Laurence Albiges, MD, PhD |
| Laurence Albiges discussed the potential of biomarkers such as PD-L1 expression, VHL mutations, and KIM-1 in guiding perioperative management for RCC. While PD-L1 expression shows promise, it has not yet been incorporated into routine practice for adjuvant therapy. VHL mutations, particularly in combination with other mutations, may help identify patients at higher risk of relapse, and KIM-1 has shown potential as both a disease-monitoring biomarker and predictor of response to adjuvant immune checkpoint inhibition. |
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| Kidney: Microbiome |
| Nazli Dizman, MD |
| Nazli Dizman discussed the growing role of the microbiome as a potential biomarker and therapeutic target in kidney cancer. She highlighted how gut microbiome composition could influence immunotherapy outcomes, with certain microbial profiles linked to better responses in metastatic RCC patients. |
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| Penile Cancer: HPV status |
| Andrea Necchi, MD |
| Andrea Necchi discussed the role of HPV status in penile cancer, emphasizing its potential as a biomarker for personalized treatment. HPV-positive penile cancer, associated with a more favorable prognosis and higher tumor mutational burden, may benefit from targeted therapies, including immune checkpoint inhibitors (ICI) and combination therapies. |
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| Molecular Imaging in Pre-Treatment Work-up of MIBC |
| Daniela-Elena Oprea-Lager, MD, PhD |
| Daniela Oprea-Lager presented on the evolving role of molecular imaging in the pre-treatment work-up of muscle-invasive bladder cancer (MIBC). She discussed the utility of ¹⁸F-FDG PET/CT for staging, particularly in detecting lymph node and distant metastases, and highlighted emerging tracers like ⁶⁸Ga-FAPI PET and 64CuCl₂, which offer improved sensitivity and specificity. |
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