Editor's Note: Approximately 101,000 new cases of bladder cancer are diagnosed annually in China, making it the 11th most common malignancy. The disease is more prevalent in southern China than in the north, and its incidence is trending toward younger age groups. Meanwhile, high-risk localized or locally advanced prostate cancer carries a substantial risk of biochemical recurrence and distant metastasis, and local treatment alone is often insufficient to address the full spectrum of clinical needs.During this year’s annual meeting, Oncology Frontier – UroStream invited Professor Zhuowei Liu of Sun Yat-sen University Cancer Center to share insights into early screening and diagnosis strategies for bladder cancer, expectations for academic platform development, and multidisciplinary management of high-risk prostate cancer.
Early Screening for Bladder Cancer: From Primary Prevention to Precision Screening of High-Risk Populations
Oncology Frontier – UroStream: Bladder cancer is more prevalent in southern China than in the north, and its incidence is trending toward younger age groups. From a public health perspective, how should early screening and diagnosis of urologic cancers be advanced? Which populations should be prioritized for screening?
Professor Zhuowei Liu: According to national statistics from 2024, approximately 101,000 new cases of bladder cancer occur annually in China, making it the 11th most common malignancy. China is a vast country, and different regions and medical institutions are at different stages of development. However, regardless of where patients live or the level of medical institution they visit, clinical practice should adopt a comprehensive disease management perspective and develop prevention and control strategies based on a systematic, full-course management approach encompassing prevention, screening, diagnosis, treatment, and rehabilitation.
First, we should make every effort to reduce the incidence of malignant tumors at the source. Smoking is a well-established major risk factor for bladder cancer. In addition, prolonged use of substandard hair dyes and occupations involving long-term exposure to certain specific chemical agents are also closely associated with bladder cancer. For these modifiable risk factors, we should focus on everyday lifestyle choices and occupational protection, proactively reducing exposure to lower the risk of bladder cancer at its source.
Second, we should prioritize the early detection of bladder tumors and identify early-stage cases among high-risk populations. On the one hand, targeted screening should be conducted among individuals with the aforementioned unhealthy lifestyle habits or a history of occupational exposure to specific chemicals to detect potential lesions as early as possible. On the other hand, bladder cancer is more common among older adults, and the male-to-female incidence ratio is approximately 3:1 to 4:1, with a substantially higher incidence in men. Therefore, screening efforts should particularly focus on high-risk groups such as older men to improve early diagnosis rates and outcomes.
Regarding screening methods, urine-based tests that detect metabolites or tumor cells are now available. These methods offer the advantages of convenient sample collection and a noninvasive approach, making them suitable for routine health examinations and preliminary outpatient screening.
Meanwhile, ultrasound is a relatively simple, noninvasive diagnostic tool that can effectively assess bladder wall thickness and identify abnormal protrusions. It is widely used as an adjunct in clinical diagnosis.
It is particularly important to emphasize that painless, intermittent gross hematuria is one of the most common clinical manifestations of bladder cancer. Any occurrence of this symptom should be taken seriously, and patients should promptly seek evaluation at a specialized medical institution for cystoscopy, urine cytology, and imaging assessment. These investigations can help clarify the diagnosis at an early stage and facilitate timely intervention.
Targeted treatment following early detection can not only improve therapeutic outcomes but also maximize organ preservation while maintaining treatment efficacy, reducing the long-term impact on patients’ lives and substantially improving their quality of life.
High-Risk Prostate Cancer: From Local Treatment to Multidisciplinary Comprehensive Management
Oncology Frontier – UroStream: High-risk localized or locally advanced prostate cancer carries a substantial risk of biochemical recurrence and distant metastasis. Relying on a single local treatment modality is often insufficient to address all clinical challenges. How do you view the current shift in high-risk prostate cancer management from local treatment toward multidisciplinary comprehensive treatment?
Professor Zhuowei Liu: This is a fundamental issue not only in urologic oncology but also in the diagnosis and treatment of all malignant tumors.
First, we must accurately determine each patient’s risk category. For patients at low risk, the goal should be to minimize treatment-related physical harm as much as possible. For high-risk patients, more intensive systemic treatment is needed.
As life sciences continue to advance, treatment approaches for cancer are becoming increasingly diverse and refined. Taking localized prostate cancer as an example, early clinical management primarily relied on radical prostatectomy. Subsequent studies demonstrated that radiotherapy could achieve treatment outcomes comparable to those of radical surgery. In recent years, neoadjuvant endocrine therapy before surgery has also been shown to further improve patient outcomes.
Therefore, multidisciplinary collaboration and integration are indispensable throughout the entire course of treatment for high-risk prostate cancer.
The key to a precision-based treatment strategy lies in three aspects:
- Accurately defining the patient’s risk category.
- Identifying the factors contributing to the high-risk classification.
- Comprehensively assessing the patient’s general health, baseline functional status before treatment, and expectations regarding functional recovery after treatment.
On this basis, multidisciplinary experts in pathological diagnosis, imaging, molecular diagnostics, surgical oncology, medical oncology, and radiation oncology should jointly discuss each case through a multidisciplinary team (MDT) approach and determine the most appropriate individualized treatment plan.
For example, are there opportunities for neoadjuvant therapy before standardized treatment begins? How can rapid recovery be promoted after treatment? Is adjuvant endocrine therapy necessary? Is adjuvant radiotherapy needed after surgery?
All these decisions require the collaborative involvement of multidisciplinary experts.
Conclusion
This interview highlights three important priorities in urologic oncology management.
First, early bladder cancer screening should begin with primary prevention, followed by targeted screening of high-risk populations. Particular attention should be paid to early warning signs such as painless gross hematuria to facilitate early detection and organ preservation.
Second, academic platforms should focus on full-course management encompassing prevention, screening, diagnosis, treatment, and rehabilitation, bringing together stakeholders to build consensus and promote standardized care.
Third, high-risk prostate cancer requires precise risk stratification and individualized treatment plans developed through multidisciplinary collaboration, with coordinated planning of neoadjuvant, local, and adjuvant therapies throughout the treatment course.
Moving from isolated interventions to comprehensive, full-course care, and from experience-based decisions toward an approach that integrates evidence-based medicine with individualized treatment, is central to improving the quality of urologic oncology care.
Professor Zhuowei Liu
