HER2-targeted antibody–drug conjugates are rapidly transforming the treatment landscape of urothelial carcinoma, with recent clinical trials positioning HER2-directed therapy as a new therapeutic pillar. Yet, this therapeutic acceleration has exposed a fundamental challenge: HER2-targeted drugs are advancing swiftly into early disease settings, but the field still lacks a coherent definition of what ‘HER2-positive’ means in urothelial cancer.

Androgen deprivation therapy (ADT) is the main treatment for advanced prostate cancer, but toxic effects can affect both physical and mental health. Awareness of these adverse effects cause some men to have reservations, leading to delay in, or refusal of, ADT. Specific counselling strategies and treatment approaches can help to manage these patients hesitant to ADT.

The approval of pembrolizumab as adjuvant immunotherapy for patients with clear cell renal cell carcinoma meeting the KEYNOTE-564 criteria set new standards and recalibrated future research and clinical needs. Yet, clinical decisions are becoming increasingly nuanced. Achieving clarity in this setting requires a cultural shift aimed at balancing evidence and uncertainty. As a community we should consider this tension as an opportunity to improve on value for patients.

Hot flushes are among the most frequent and persistent adverse effects of androgen deprivation therapy for prostate cancer but remain under-recognized and often undertreated. Insights into KNDy-neuron-driven thermoregulatory dysfunction provide a strong mechanistic rationale for using neurokinin 3 and dual neurokinin 1 and 3 antagonists as a new non-hormonal treatment strategy.

Women with bladder cancer face differences in diagnosis and treatment and have worse outcomes than men despite lower incidence. This disparity cannot be univocally ascribed to bias or biology but reflects a convergence between these two aspects across diagnostic pathways, treatment delivery and tumour biology. Addressing these issues demands a coordinated, multi-pronged action across research, clinical practice and health policy.