Onkológia 3/2026

Current trends in the diagnosis and management of urothelial carcinoma

Urothelial carcinoma is among the most common malignancies of the urinary tract, and its management has undergone rapid evolution in recent years. Advances in diagnostics include the introduction of multiparametric magnetic resonance imaging with the VI-RADS scoring system, advanced cystoscopic imaging techniques, the development of artificial intelligence, and the implementation of liquid biopsy based on the analysis of circulating tumor DNA (ctDNA) and urinary tumor DNA (utDNA). Molecular diagnostics is also gaining increasing importance, enabling the identification of actionable therapeutic targets, particularly FGFR2/3 alterations and HER2 expression. In the treatment of non–muscle-invasive bladder cancer (NMIBC), bladder-preserving approaches have expanded to include gene therapy, immunotherapy, and novel intravesical drug-delivery systems. In muscle-invasive bladder cancer (MIBC), the NIAGARA, KEYNOTE-905/EV-303, and KEYNOTE-B15/EV-304 trials have led to major changes in perioperative treatment and have renewed interest in bladder- -preservation strategies for selected patients. In metastatic disease, the combination of enfortumab vedotin and pembrolizumab has become the new first-line standard of care, while erdafitinib and HER2-targeted antibody–drug conjugates (ADCs) are expanding the options for personalized treatment. The aim of this review is to summarize the most important diagnostic and therapeutic advances shaping clinical practice in 2026.

Keywords: urothelial carcinoma, bladder cancer, immunotherapy, antibody-drug conjugates, enfortumab vedotin, biomarkers, circulating tumor DNA, personalized medicine