This review examines the evolution, clinical efficacy, and future directions of trimodal therapy (TMT) as a bladder-preserving treatment option for muscle-invasive bladder cancer. A nonsystematic literature search was conducted on PubMed in October 2024 using the following keywords: “muscle invasive bladder cancer,” “bladder preservation,” “trimodal therapy,” “chemoradiotherapy,” and “radiation therapy.” Papers published between 2000 and 2024 were included, and original articles, reviews, and editorials written in English were selected. Relevant studies were organized and cited in the analysis. TMT, which consists of transurethral resection of the bladder tumor, chemotherapy, and radiotherapy, demonstrated comparable oncologic outcomes to radical cystectomy (RC) in terms of 5-year overall survival (36%–74%) and cancer-specific survival (50%–82%). Long-term data from multiple studies indicate that TMT can preserve bladder function while maintaining acceptable survival rates. The recent integration of immune checkpoint inhibitors with TMT shows promise, further improving tumor control and expanding the eligible patient population. However, standardized protocols and long-term follow-up data are still lacking. TMT serves as an effective alternative to RC in selected patients, offering similar oncologic outcomes while preserving quality of life. Further research is needed to establish standardized protocols and to refine patient selection criteria to optimize treatment outcomes.

In the treatment of metastatic lesions in advanced renal cell carcinoma (RCC), no clear consensus exists regarding whether immunotherapy should be combined with surgical resection or metastasectomy. Systemic therapies have significantly improved outcomes for advanced RCC patients and extended both progression-free and overall survival. However, complete disease eradication with drug therapy alone remains rare, and this limitation has renewed interest in metastasectomy for metastatic RCC. Although robust evidence is still lacking, many researchers have suggested that aggressive surgical approaches involving metastasectomy may improve survival in selected patients by controlling the cancer burden through the resection of primary and metastatic lesions. Novel immunotherapies have transformed solid tumor treatment, prompting a reevaluation of the role of metastasectomy. Recent studies have shown promise in combining systemic therapies with metastasectomy for metastatic RCC, emphasizing the need for further research and individualized, multidisciplinary approaches.

Approximately 20% of newly diagnosed renal cell carcinoma (RCC) cases exhibit synchronous metastases, while 20% to 40% of initially localized RCC cases subsequently develop distant metastases after surgical intervention. In the management of oligometastatic RCC with a restricted number of metastatic sites, metastasis-directed therapy (MDT) plays a crucial role within the multimodal therapeutic framework. MDT, which encompasses surgical metastasectomy and stereotactic body radiation therapy (SBRT), seeks to prolong survival and increase quality of life by offering an interruption of systemic therapy. Research has demonstrated that complete metastasectomy is essential for attaining an optimal survival advantage. The criteria for patient selection remain ambiguous; nonetheless, it is crucial to consider the location of metastases and patient risk stratification. SBRT is demonstrably successful in RCC and is being progressively utilized in oligometastatic RCC. The sequencing of advanced systemic agents with comprehensive local treatment of primary and metastatic sites for oligometastatic RCC has demonstrated potential.

Bladder cancer remains a significant health challenge. Early and accurate diagnoses are crucial for effective treatment and improved patient outcomes. In recent years, artificial intelligence (AI) has emerged as a powerful tool in the medical field, showing great promise in advancing the bladder cancer diagnosis. This review explores the current state and potential of AI technologies, including machine learning algorithms, deep learning networks, and computer vision, in enhancing the diagnostic process for bladder cancer. AI systems can analyze vast amounts of data from various sources, such as medical imaging, genomic data, and electronic health records, enabling the identification of subtle patterns and biomarkers that may indicate the presence of bladder cancer. These systems have demonstrated high accuracy in detecting cancerous lesions in imaging modalities such as cystoscopy, ultrasonography, and computed tomography scans, often surpassing human performance. Moreover, AI-driven diagnostic tools can assist in risk stratification, predicting disease progression, and personalizing treatment plans, thereby contributing to more targeted and effective therapies.

Purpose: This study evaluated the feasibility and safety of single-port transvesical robotic radical prostatectomy. Materials and Methods: Four patients underwent a transvesical robotic radical prostatectomy using a singleport robotic system. The procedure involved a 2.5-cm suprapubic incision to access the anterior bladder wall, which was incised by approximately 2 cm. Utilizing a floating-docking technique. Results: All surgeries were successfully completed without the need for additional ports or open conversion. Intraoperative complications were not observed. The median (interquartile range, IQR) console time was 159 (96–198) minutes. The median (IQR) estimated blood loss was 350 (300–700) mL. The median (IQR) duration for Foley catheter removal and patient discharge postsurgery was 7.5 (6–10) days. None of the patients experienced total incontinence after Foley catheter removal, and at 1-month postsurgery, all patients used only a safety pad. Pathology revealed positive surgical margins in 2 patients (both with pT3a and pT3b), with one of these patients having a persistent prostate-specific antigen level of 0.48 ng/mL at 1-month postsurgery. Additionally, 2 patients experienced gross hematuria within 2-week postdischarge. Conclusion This series demonstrates that single-port robotic transvesical radical prostatectomy is a feasible procedure with favorable perioperative functional outcomes. This offers the advantage of rapid continence recovery without oncological disadvantages.

Bacillus Calmette-Guérin (BCG) remains the cornerstone in the treatment of high-risk non-muscle-invasive bladder cancer (NMIBC), effectively preventing recurrence and progression. Unfortunately, a significant proportion of patients are classified as BCG-unresponsive, and there have been no definite alternative treatments for these disease group except for radical cystectomy, which is still challenging and sometimes not applicable. Therefore, there has been a need for alternative bladder-preserving treatments for patients who desire a bladder-sparing approach or are too frail for major surgery. Intravesical therapies, such as gemcitabine, mitomycin C and docetaxel, are mostly studied approaches, showing some promising results. However, no definitive conclusion has be drawn because of the heterogeneity of the studies and protocols and the limited number of patients enrolled in most of these studies. Immunotherapy and anti-inflammatory agents, though promising, require further validation through ongoing clinical trials to ensure their safety and efficacy. Gene therapy is also being explored, though it is in its early stages, with challenges in gene delivery and immune regulation still to be addressed. Photodynamic therapy and hyperthermia, particularly in combination with other treatments like intravesical chemotherapy, have shown potential in improving outcomes for BCG-unresponsive patients, though they are not yet considered first-line treatments. While these novel approaches hold promise, more robust data and clinical trial results are necessary to guide treatment protocols. In conclusion, ongoing research and clinical trials will continue to shape the future of NMIBC management, with the aim of providing more effective and bladder-preserving options for patients.

Purpose: Myosteatosis, defined as fat infiltration in muscle tissue, has been linked to poor outcomes in various cancers. However, the prognostic impact of myosteatosis on renal cell carcinoma (RCC) remains poorly understood. This study evaluated the predictive value of myosteatosis based on an artificial intelligence (AI)-driven computed tomography (CT) analysis in patients with localized RCC who underwent partial nephrectomy. Materials and Methods: This retrospective study included 170 patients with localized RCC who underwent partial nephrectomy at a single institution between 2011 and 2017. Myosteatosis was assessed on CT scans using an AI-based tool. The patients were categorized into 2 groups according to the presence or absence of myosteatosis. The clinical outcomes, including disease-free survival (DFS), were compared to determine the prognostic significance of myosteatosis. Results: Of 170 patients, 36 (21.2%) were diagnosed with myosteatosis. These patients were older and had a higher body mass index. The myosteatosis group had a higher proportion of females than the no myosteatosis group. Lymphovascular invasion and tumor necrosis were prevalent pathological features in patients with myosteatosis. Kaplan-Meier analysis demonstrated that myosteatosis was associated with significantly shorter DFS (p<0.05). Multivariate analysis confirmed that myosteatosis independently predicted adverse outcomes in patients with localized RCC. Conclusion AI-based CT analysis of myosteatosis is a reliable method for improving the risk stratification of patients with localized RCC. Patients with myosteatosis demonstrate poor pathological features and shorter DFS. These findings highlight the potential of AI-driven body composition analysis to refine prognostic models and personalized treatment strategies.