The critical role of advocacy in urologic oncology

Galloway is a urology resident at Vanderbilt University Medical Center in Nashville, Tennessee, and Talwar is an assistant professor of urology and Medical Director of Episodes of Care, Population Health at Vanderbilt University Medical Center.

Advocacy is a critical extension of clinical care in urologic oncology, with direct implications for patient outcomes, access to treatment, and health equity. Beyond the bedside, urologists play an essential role in shaping policies that influence screening, drug availability, research funding, and disparities in care. From engagement with patient advocacy organizations to direct involvement in legislative efforts, clinicians have multiple avenues to make an impact on the systems that govern cancer care delivery.

One of the most effective vehicles for advocacy in urologic oncology is participation in patient advocacy networks. These organizations unite patients, clinicians, researchers, and policy makers around a shared mission: improving outcomes through awareness, research funding, and policy change.

The Bladder Cancer Advocacy Network (BCAN) is a leading example of successful advocacy in this space. BCAN works with many federal agencies, such as the National Institutes of Health, Congressionally Directed Medical Research Programs, and US Department of Defense, to advocate for federal funding for bladder cancer research, which has received significantly less federal funding than other cancers in the past.¹ They also advocated for the PACT Act, a law that expands US Department of Veterans Affairs (VA) health care and benefits for veterans who have exposure to burn pits and other toxic substances.¹ BCAN helped curate and collect evidence to substantiate the association between burn pits and bladder cancer and is serving as a resource as the VA reviews scientific data on the subject.¹ Members of the organization also meet regularly with members of Congress, and BCAN sends and signs on to letters to federal agencies and Congress to support their advocacy goals. They are a prime example of the impact of policy advocacy in urologic oncology.

In parallel, organized medicine provides structured opportunities for clinician-led advocacy. The American Urological Association (AUA) Annual Urology Advocacy Summit is a prominent example that brings urologic providers, patients, and stakeholders to Capitol Hill to lobby for important issues related to our field. Members of the AUA from all over the country meet with their congressional representatives and senators to lobby for our patients and their needs. Although many of the “asks” to Congress include issues that are not specifically related to urologic oncology, several of the proposed bills and requests for Congress over the past few years have directly affected patients with urologic cancer. In 2023, attendees of the AUA Annual Urology Advocacy Summit urged their congressional representatives to back the Prostate-Specific Antigen Screening for High-risk Insured Men Act. The bill would give men who discuss prostate cancer screening with their physicians access to prostate-specific antigen (PSA) testing without burdensome cost-sharing requirements, with the legislation specifically targeting coverage for African American men and men with a family history of prostate cancer who fall outside existing US Preventive Services Task Force (USPSTF)–covered screening recommendations. Advocates framed the effort as a push to have men at high risk for prostate cancer treated as though they carried a USPSTF grade of A or B for PSA screening so that insurers would be required to cover testing without co-pays that might otherwise discourage screening among men unaware of its benefits. The goal was to reduce cost as a barrier and expand access to screening for these higher-risk populations.^2,3

In 2025, the shortage of numerous urologic drugs was a key focus of the AUA summit. Given recent shortages in medications such as BCG and cisplatin chemotherapy, participants of the summit lobbied for the US Department of Health and Human Services to create a “vulnerable medications” list.⁴ This would help urologists identify which drugs are vulnerable to shortages and prepare for future stressors on the supply chain. The AUA Annual Urology Advocacy Summit is a great example of how health policy influences our daily practice and patient care. It is an opportunity for all members of the field of urology to be involved and advocate for patients.

Evolving health policy also plays a role in mitigating health disparities seen in our field. Disparities exist across racial and gender groups in urologic oncology; for example, Black men are more likely to be diagnosed with advanced prostate cancer and have higher mortality rates than White men, and women are more likely to be diagnosed with more advanced bladder cancer than men.⁵ There are many possible reasons for these differences, and some possibilities include socioeconomic barriers such as poor insurance coverage, high out-of-pocket costs, and limited access to providers in low-resource and rural areas leading to delays or lack of care.⁴ Findings from prior studies have shown that patients with prostate cancer who had insurance were less likely to present with metastatic disease and more likely to be treated if they developed high-risk disease than uninsured patients.⁶

Policy interventions can meaningfully address these gaps. Expanding insurance coverage, reducing financial toxicity, and incentivizing care delivery in underserved areas are all strategies that can improve access and outcomes. Additionally, policies that support screening in high-risk populations and fund research focused on disparities are essential. Urologic oncologists are uniquely positioned to advocate for these changes, as they directly observe the consequences of inequitable systems in clinical practice.

Overall, health policy plays an important role in the field of urologic oncology and has a large impact on patient care. There are many ways for urologic oncologists to expand their impact beyond the clinical sphere and participate in health advocacy efforts, such as participation in patient advocacy groups, including BCAN and the AUA Annual Urology Advocacy Summit. Involvement in health policy is paramount to continue to advance our field and improve patient care.

REFERENCES

1.Policy advocacy. Bladder Cancer Advocacy Network. Accessed August 10, 2026. https://tinyurl.com/4744625e

2. Clarke H. 2023 AUA Summit focuses on 4 main legislative priorities. Urology Times.March 9, 2023. Accessed August 10, 2026. https://tinyurl.com/mue98jyk

3.Dr. Murphy highlights advocacy for PSA screening at the 2023 AUA Summit. Urology Times. March 15, 2023. Accessed August 10, 2026. https://tinyurl.com/5cjtrcst

4. Talwar R, Clarke H. Ruchika Talwar, MD, discusses ongoing drug shortages in urology. Urology Times. March 18, 2025. Accessed August 10, 2026. https://tinyurl.com/5he29n5u

5. Puri D, Pandit K, Choi N, Rose BS, McKay RR, Bagrodia A. Striving for equity: examining health disparities in urologic oncology. Cancers (Basel). 2024;16(21):3559. doi:10.3390/cancers16213559

6. Mahal BA, Aizer AA, Ziehr DR, et al. The association between insurance status and prostate cancer outcomes: implications for the Affordable Care Act. Prostate Cancer Prostatic Dis. 2014;17(3):273-279. doi:10.1038/pcan.2014.23