There is a Growing Need For Genetic Testing and Precision Medicine in GU Cancers

Genetic testing in genitourinary (GU) cancers is critical for guiding targeted therapies and precision medicine, as well as assessing familial cancer risks and optimizing treatment regimens, as evidenced by data shared at the 2025 Annual ASCO GU Symposium.

The importance of genetic testing and precision medicine in prostate, bladder and kidney cancers is growing, according to Dr. Chandler Park. He went on to emphasize that patients should discuss genetic testing with their oncologist to determine eligibility for targeted therapies.

In an interview following the meeting, Park — a medical oncologist of Genitourinary Medical Oncology at the Norton Healthcare Institute, in Louisville, Kentucky — sat down with CURE® to discuss his key takeaways from the meeting, including clinical trial updates in GU cancer and what to know about precision medicine.

CURE: What is your key takeaway for patients based on outcomes of the ASCO GU Symposium, and how does it relate to genetic testing?

Park: One key [takeaway from the ASCO GU Symposium] is for patients that have prostate cancer [or those with] family and loved ones [with prostate cancer]. It is important to [speak with] your oncologist. I help out at the medical schools, and I can sense that certain people go into oncology because they love people, and [these people] are open to feedback. Therefore, I would highly encourage that whenever you see an oncologist, if you have a history of prostate cancer in the family, ask for genetic testing — not just germline testing, but somatic.

For patients with bladder cancer, what would you want them to know about the conference? Should they also be aware of genetic testing?

Speaking to bladder cancer, there was another study that was updated, and this is something that all patients and their family members should know about, and that's called the phase 3 NIAGARA study. This is something that's applicable today. So, what's the NIAGRA study? The NIAGRA study evaluated patients in which we want to get a high cure rate. Previously, for patients that had cystectomy, the standard of care was chemotherapy, surgery, and then afterwards was to watch followed by consideration of immunotherapy, but there was no overall survival.

However, based on the ASCO GU update, if a patient received chemotherapy with an immunotherapy called Imfinzi (durvalumab), they had a much higher chance that after surgery, they would remain cured. Everybody today that has stage two bladder cancer and received treatment before the surgery should ask their medical oncologist for chemotherapy and an immunotherapy. Then, after surgery, maybe even consider immunotherapy afterwards. That's something I would encourage.

Because genetic testing and personalized medicine ensures patients receive the most effective and personalized care, what is the importance of continually considering these approaches?

One of the things about GU cancers is every patient — whether you have kidney cancer, bladder cancer or prostate cancer — needs to be evaluated for precision medicine. This is something I would share with my patients and their family members: ask for precision medicine. For example, let's say a patient has kidney cancer and they have specific gene mutations, such as von Hippel Lindell (VHL) germline mutations. If they do, I would consider them for evaluation by a genetic counselor to see if they have a condition called von Hippel Lindell disease, and in the future, I would consider them for treatment with a medication called Welireg [belzutifan]; that's a precision medicine now.

In bladder cancer… there has been an explosion of precision medicine. There are three highlights that I would talk about with somebody with bladder cancer to chat with their oncologist about. First — specifically in stage 4 disease — do I have a gene mutation? Do I have a gene mutation called FGFR3, because if you do, you can receive a medication called Balversa [erdafitinib]. [This agent] has a strong 40% to 45% response rate and is better than chemotherapy. The second thing that's emerged in the last six months is asking your oncologist, if you have a gene mutation called HER2. HER2 is something that oncologists know in terms of the breast cancer world, but if a patient has stage 4 bladder cancer and they have a HER2 gene mutation, there's a 60% to 65% chance that if they receive a medication called Enhertu [fam-trastuzumab deruxtecan-nxki], that it would work. I would ask if they have a HER2 gene mutation.

In terms of prostate cancer and precision medicine, we have to check for BRCA1, BRCA2, PALB2, CDK12 [and others]. I would ask, in terms of, when you see the oncologist, whether you have prostate, kidney or bladder cancer, ask that oncologist about the role of precision medicine and the role of next-generation sequencing. This way, you are or your family member is receiving precision medicine, which is the best treatment for their specific cancer.

Transcript has been edited for clarity and conciseness.

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