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Precision Care for Hereditary Urologic Cancers: Genetic Testing, Counseling, Surveillance, and Therapeutic Implications. Curr. Oncol. 2025, 32, 698. [https://doi.org/](https://doi.org/)[ ](https://doi.org/)[10.3390/curroncol32120698](10.3390/curroncol32120698)  \nCopyright: © 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ([https://creativecommons.org/](https://creativecommons.org/)[ ](https://creativecommons.org/)[licenses/by/4.0/](licenses/by/4.0/)) .  \nDepartment of Urology, Toho University Sakura Medical Center, Sakura 285-8741, Japan;  \n[takatoshi.soumoto@med.toho-u.ac.jp](takatoshi.soumoto@med.toho-u.ac.jp) (T.S.); [rino.ikeda@med.toho-u.ac.jp](rino.ikeda@med.toho-u.ac.jp) (R.I.);  \n[naoki.ishitsuka@med.toho-u.ac.jp](naoki.ishitsuka@med.toho-u.ac.jp) (N.I.); [takahide.noro@med.toho-u.ac.jp](takahide.noro@med.toho-u.ac.jp) (T.N.);  \n[yuta.suzuki@med.toho-u.ac.jp](yuta.suzuki@med.toho-u.ac.jp) (Y.S.); [shouta.iijima@med.toho-u.ac.jp](shouta.iijima@med.toho-u.ac.jp) (S.I.); [yuuka.kizuki@med.toho-u.ac.jp](yuuka.kizuki@med.toho-u.ac.jp) (Y.S.);  \n[ryou.oka@med.toho-u.ac.jp](ryou.oka@med.toho-u.ac.jp) (R.O.); [takumi.endou@med.toho-u.ac.jp](takumi.endou@med.toho-u.ac.jp) (T.E.); [naoto.kamiya@med.toho-u.ac.jp](naoto.kamiya@med.toho-u.ac.jp) (N.K.);  \n[hiroyoshi.suzuki@med.toho-u.ac.jp](hiroyoshi.suzuki@med.toho-u.ac.jp) (H.S.)  \n* Correspondence: [takanobu.utsumi@med.toho-u.ac.jp](takanobu.utsumi@med.toho-u.ac.jp); Tel.: +81-43-462-8811  \nSimple Summary  \nSome urologic cancers arise from inherited genetic variation. This review offers pragmatic guidance on when to pursue genetic testing, which genes are most consequential, how results should direct screening and treatment, and how to ensure equitable access for all patients. We address prostate cancer, renal cell carcinoma, and urothelial carcinoma, adrenal tumors, and testicular germ cell tumors. We specify who should be offered testing and highlight genotype-informed therapies. We also provide counseling checklists and clinic  \nworkflows that health systems can adopt. Collectively, these recommendations can orient future studies, inform clinical and coverage policies, and advance equitable, real-world cancer care.  \nAbstract  \nHereditary predisposition substantially shapes prevention and management across urologic oncology. This narrative review synthesizes contemporary, practice-oriented guidance on whom to test, what to test, how to act on results, and how to implement care equitably for hereditary forms of prostate cancer, renal cell carcinoma (RCC), urothelial carcinoma, pheochromocytoma/paraganglioma (PPGL), and adrenocortical carcinoma (ACC) . We delineate between forms of indication-driven germline testing (e.g., universal testing in metastatic prostate cancer; early-onset, bilateral/multifocal, or syndromic RCC; reflex tumor mismatch repair (MMR)/microsatellite instability (MSI) screening in upper-tract urothelial carcinoma (UTUC); universal testing in PPGL; universal TP53 testing in ACC) and pair these strategies with minimum actionable gene sets and syndrome-specific surveillance frameworks. Key points include targeted prostate-specific antigen screening in BRCA2 carriers and the impact of BRCA/ATM variants on reclassification during active surveillance; major hereditary RCC","cbCaiqsggdwyrJpn","https://ap.wps.com/l/cbCaiqsggdwyrJpn","pdf",470793,24,"English","# Simple Summary\n# Abstract\n# Keywords\n# Introduction\n## Hereditary determinants in urologic oncology\n## Lynch syndrome and UTUC\n## Polygenic architecture of TGCTs","[{\"question\":\"When should genetic testing be pursued for hereditary urologic cancers?\",\"answer\":\"The review provides guidance on pursuing genetic testing based on indications across multiple cancer types, including universal testing in specific metastatic or early-onset/syndromic scenarios. It also clarifies which testing strategies best fit each condition.\"},{\"question\":\"How do genetic testing results change screening and treatment?\",\"answer\":\"Results should direct targeted screening approaches and genotype-informed therapies, including reclassification during active surveillance for certain variants. Syndrome- and genotype-tailored surveillance frameworks are matched to actionable gene sets.\"},{\"question\":\"Which cancer types and genetic syndromes are covered in the review?\",\"answer\":\"The review addresses hereditary forms of prostate cancer, renal cell carcinoma, urothelial carcinoma, pheochromocytoma/paraganglioma, and adrenocortical carcinoma. It also discusses Lynch syndrome, von Hippel–Lindau disease, and Li–Fraumeni syndrome, and notes that typical testicular germ cell tumor presentations are largely polygenic.\"}]","Precision Care for Hereditary Urologic Cancers - Review | PDF",1790219343]