New research presented at ASCO GU 2026 uncovers critical gaps in testing, treatment access, and outcomes among patients with prostate and bladder cancer, paving the way toward more equitable cancer care.
At ASCO GU 2026, Flatiron presented six studies spanning disease states, biomarker status, and treatment types for prostate and bladder cancers, drawing insights from more than 420,000 patients treated across community and academic care settings. Together, they reveal a critical gap: despite the expansion of treatment options, many patients are still not receiving the care they need.
For medical and clinical teams, these real-world insights can inform targeted educational initiatives to optimize treatment selection, enable discussions around access barriers, guide post-marketing surveillance strategies, and ultimately unlock better outcomes for patient populations currently underserved by existing care paradigms.
In prostate cancer: PARP inhibitors, PSMA-PET imaging, and other advances are transforming prostate cancer care, however critical questions remain around ARPI selection, HRR testing timing, post-Pluvicto treatment, and identifying eligible patients for aggressive upfront therapy.
In muscle-invasive bladder cancer: peri-operative approvals, emerging biomarkers like ctDNA and new targeted therapies are expanding options. With these new options, clinical and medical affairs teams can now shift to optimizing treatment selection and sequencing using insights from RWE to improve outcomes while avoiding overtreatment.
Why are patients with non-BRCA HRR mutations underreceiving PARP inhibitors?
An analysis of nearly 28,000 patients with mCRPC, drawn from Flatiron's prostate cancer Panoramic dataset of 370,000 patients, found that 66% of mutations were non-BRCA mutations, most commonly in ATM, CHEK2, and CDK12 genes. However, these patients were far less likely to receive PARP inhibitors: only 29% compared to 48% of those with BRCA mutations. When they did receive treatment, they started later in their disease course and experienced shorter survival (12.3 vs. 15.2 months).
These results suggest that patients with non-BRCA DNA repair mutations may respond differently to PARP inhibition, underscoring the necessity for broader genetic testing in advanced prostate cancer and potentially tailored treatment strategies beyond standard PARP inhibition.
Why has BRCA testing in patients with metastatic castration-resistant prostate cancer stalled?
Despite the availability of PARP inhibitors for patients with metastatic castration-resistant prostate cancer (mCRPC) and BRCA mutations, testing rates have plateaued. Of 6,761 patients studied between 2018 and 2024, only 51% underwent BRCA testing. While rates improved from 37% in 2018 to 57% in 2023, progress has stalled around 55% since 2020. Importantly, the study revealed significant disparities: older patients, those of Hispanic backgrounds, those with poor health status, and those diagnosed before 2020 were significantly less likely to be BRCA tested.
These findings highlight critical gaps in equitable cancer care and underscore the urgent need to improve BRCA testing access and awareness across all oncology practices to ensure all eligible patients benefit from personalized medicine.
How are patients treated after lutetium-177 in metastatic castration-resistant prostate cancer?
As radioligand therapy becomes more common in mCRPC, a critical question emerges: what comes next? Among 740 patients who received lutetium-177 vipivotide tetraxetan, 22% went on to receive additional treatment but with striking heterogeneity. More than 40 different treatment combinations were used.
Median survival after Lu-177 was only 8.0 months overall, with taxane-naïve patients faring better (13.5 months) than those previously treated with taxanes (6.8 months). These findings underscore the urgent need for evidence-based guidance on post-radioligand therapy management.
How do enfortumab vedotin eligibility criteria affect treatment access in advanced bladder cancer?
In another study, among 3,500 patients with locally advanced or metastatic urothelial carcinoma, 28% were unsuitable for enfortumab vedotin due to conditions such as nerve damage, poor kidney function, diabetes, or low performance status. Nearly one-quarter of these vulnerable patients received no treatment at all. Median survival was only 9.3 months for unsuitable patients versus 17.0 months for those deemed suitable for the therapy.
These findings underscore the need for individualized treatment decisions in bladder cancer as rigid eligibility criteria may be excluding patients from beneficial therapies. With different approaches producing similar outcomes in frail patients, prioritizing patient preferences, quality of life, and risk tolerance is essential for this underserved population.
Can cisplatin-ineligible bladder cancer patients still benefit from treatment?
Leveraging Flatiron’s bladder cancer Panoramic dataset comprising >40K patients, researchers found that in muscle-invasive bladder cancer, 10% of surgical candidates were deemed cisplatin-ineligible. Yet nearly half of these patients still received cisplatin-based chemotherapy and showed improved survival compared to those who didn't. This suggests that cisplatin eligibility criteria may be overly restrictive and that patients labeled as ineligible could still derive substantial clinical benefit.
Why are most advanced bladder cancer patients not tested for FGFR3 mutations?
Detailed biomarker analysis from 3,700 advanced bladder cancer patients revealed only 41% of patients underwent FGFR3 testing—and just 28% were tested before starting first-line treatment (when identification matters most for treatment planning). Among those with FGFR3 alterations, only 41% went on to receive erdafitinib, the FDA-approved targeted therapy.
Undertested populations include older patients, Black patients, and those with specific clinical profiles—including lower urinary tract tumors or earlier-stage disease at diagnosis—many of whom remain without access to life-extending targeted therapies.
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How can life sciences teams use real-world evidence to close treatment gaps?
For medical affairs, HEOR, and RWE teams and researchers, these studies illuminate several critical priorities:
1. Testing disparities require targeted interventions. Age, race, and disease characteristics shouldn't determine access to precision medicine. Understanding where and why testing gaps occur is the first step toward closing them.
2. Real-world evidence captures how oncology care is delivered, beyond clinical trials. Patients often excluded from trials—the elderly, those with comorbidities, and those from underrepresented racial and socioeconomic backgrounds—represent a substantial portion of clinical practice. Only RWE provides visibility into their outcomes and treatment decisions.
3. Treatment sequencing remains poorly understood. As therapeutic options expand, evidence on optimal sequencing—particularly after novel therapies like Lu-177—becomes increasingly critical.
Implementing real-world evidence to improve GU cancer care
These insights provide a roadmap for translating evidence to value and, ultimately, decisive clinical action. Realizing the promise of precision oncology and its real-world practice will require sustained attention to testing access, treatment equity, and evidence generation across all types of genitourinary cancer.
Explore the full research summaries
- PARP inhibitor outcomes beyond BRCA mutations
- Persistent gaps in BRCA mutation testing among mCRPC patients
- Post-Lu-177 treatment patterns and survival
- Treatment patterns in frail patients with advanced urothelial carcinoma
- Neoadjuvant therapy in cisplatin-ineligible bladder cancer
- FGFR3 testing patterns and disparities in urothelial cancer
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