Andrea Necchi, MD, outlines why rare GU cancers demand faster diagnosis

In this video, recorded at the 41st Annual European Association of Urology Congress in London, United Kingdom, Andrea Necchi, MD, an associate professor of oncology at Vita-Salute San Raffaele University in Milan, Italy, and Director of GU Medical Oncology at San Raffaele Hospital, addresses the diagnostic and therapeutic challenges surrounding rare genitourinary (GU) cancers, emphasizing that this category encompasses a broad and diverse range of tumor types, histologies, and anatomical origins—each requiring its own diagnostic vigilance.

On diagnostic pitfalls, Necchi highlights penile cancer as a particularly common source of delay. Urologists must treat any suspicious penile lesion as a potential squamous cell carcinoma and move quickly to biopsy. Once a primary diagnosis is confirmed, accurate assessment of groin lymph node involvement is critical, as it directly affects the patient's chances of cure. For testicular cancer, tumor markers—alpha-fetoprotein and beta-hCG—are essential tools whenever a suspicious testicular nodule is identified, and the diagnostic work-up should proceed rapidly to catch stage 1, potentially curable disease. Necchi also flags variant histologies within bladder cancer as an underappreciated diagnostic challenge. Pathologists must identify and quantify the contribution of variant histology relative to the urothelial carcinoma component, as this directly influences surgical planning and systemic therapy decisions.

On targeted and immunotherapy advances, Necchi is candid: For most rare GU malignancies, these treatments remain in early stages. Immunotherapy has no established role in testicular cancer, and its positioning remains unclear for adrenal cancer, non-clear cell renal cell carcinoma, and bladder cancer variant histologies. The clearest exception is HPV-positive penile cancer, where immunotherapy has a reasonably well-supported role—either as an alternative to chemotherapy or in the post-chemotherapy setting for patients with advanced disease.

Overall, Necchi's message is one of urgency and precision: faster diagnosis and better histological characterization are the most actionable levers clinicians have today.