Renal cancer ranks twelfth in incidence among cancers worldwide. Despite improving outcomes due to better therapeutic options and strategies, prognosis for those with metastatic disease remains poor. Current systemic therapeutic approaches include inhibiting pathways of angiogenesis, immune checkpoint blockade, and mTOR inhibition, but inevitably resistance develops for those with metastatic disease, and novel treatment strategies are urgently needed. Emerging molecular and epidemiological evidence suggests that quinazoline-based α1-adrenoceptor-antagonists may have both chemopreventive and direct therapeutic actions in the treatment of urological cancers, including renal cancer. In human renal cancer cell models, quinazoline-based α1-adrenoceptor antagonists were shown to significantly reduce the invasion and metastatic potential of renal tumors by targeting focal adhesion survival signaling to induce anoikis. Mechanistically these drugs overcome anoikis resistance in tumor cells by targeting cell survival regulators AKT and FAK, disrupting integrin adhesion (α5β1 and α2β1) and engaging extracellular matrix (ECM)-associated tumor suppressors. In this review, we discuss the current evidence for the use of quinazoline-based α1-adrenoceptor antagonists as novel therapies for renal cell carcinoma (RCC) and highlight their potential therapeutic action through overcoming anoikis resistance of tumor epithelial and endothelial cells in metastatic RCC. These findings provide a platform for future studies that will retrospectively and prospectively test repurposing of quinazoline-based α1-adrenoceptor-antagonists for the treatment of advanced RCC and the prevention of metastasis in neoadjuvant, adjuvant, salvage and metastatic settings.

Background/Objectives: Radical cystectomy with urinary diversion is the standard treatment for patients with muscle-invasive bladder cancer, which represents a complex, preference-sensitive decision about the diversion options. To facilitate patient-clinician shared decision-making, we developed and evaluated the feasibility and acceptability of the Personal Patient Profile–Bladder Cancer (P3-BC), a web-based decision support system for patients considering urinary diversion options. Materials and Methods: We employed an iterative development approach following an established framework, including qualitative assessments of radical cystectomy patients’ (n = 30) needs to inform content development, followed by usability testing with 10 key stakeholders. We then conducted a feasibility study with patients newly diagnosed with bladder cancer undergoing cystectomy. Feasibility was assessed through P3-BC completion rates among patients randomized to the intervention and study retention rates. Acceptability was measured using a program-based 12-item questionnaire integrating the six-item Acceptability E-Scale. Secondary outcomes included decisional conflict, shared decision-making, psychological distress, and decisional regret. Results: Of 114 eligible patients, 24 provided consent (21% consent rate), and 15 were randomized to receive the P3-BC intervention (n = 10) or usual care (n = 5). Retention was 93% at 1 month and 73% at 3 months. Among intervention participants, P3-BC achieved high feasibility (100% accessed the program) and acceptability, with 86% reporting overall satisfaction and 86% reporting ease of use. No statistically significant between-group differences were observed in secondary outcomes. Although the study was not powered to examine group differences, numerical trends suggest improvements in decisional conflict and symptom burden over time, particularly in the intervention group. Conclusions: P3-BC demonstrated feasibility and acceptability as a web-based decision support intervention for patients with bladder cancer considering cystectomy and urinary diversion. Primary barriers to enrollment included treatment burden, limited diagnosis-treatment time, and technology concerns. Findings support progression to an adequately powered randomized controlled trial to evaluate clinical effectiveness.

Background/Objectives: Active surveillance (AS) is the recommended management strategy for localized, early-stage prostate cancer. Despite promising cancer-specific outcomes, up to one-third of men discontinue AS and undergo radical prostatectomy without evidence of disease progression, often because of stress, anxiety, uncertainty, and unmet supportive care needs. Evidence-based psychosocial interventions tailored to men on AS are lacking. We aimed to: (1) adapt the Stress Management and Resilience Training (SMART) program to address the unique psychosocial and supportive care needs of men with prostate cancer on AS (SMART-AS), and (2) evaluate the feasibility and acceptability of SMART-AS. Methods: Following the Assessment, Decision, Adaptation, Production, Topical Experts, Integration, Training, Testing (ADAPT-ITT) framework, we adapted SMART for men with prostate cancer on AS (SMART-AS) informed by our prior qualitative study and expert input. Next, we conducted a single-arm pilot feasibility study at one large urban academic medical center. Participants attended eight weekly 90-minute telehealth group SMART-AS sessions. Feasibility and acceptability were evaluated one-week post-intervention. Results: Based on our prior qualitative study and expert input, core SMART-AS components included content targeting stress, anxiety, communication, and self-management. In total, 30 participants were enrolled in the pilot feasibility study and completed baseline assessments (mean age = 71 years, standard deviation = 8.3); 26/30 (86.7%) completed six out of eight SMART-AS sessions, and 17/30 (56.7%) completed post-intervention assessments. Nearly all (16/17, 94.1%) reported that they would recommend SMART-AS to others. Most agreed that SMART-AS helped them talk to clinicians (13/17, 76.5%), reduced anxiety (13/17, 76.5%), enhanced coping skills for AS challenges (15/17, 88.2%), and supported self-care (15/17, 88.2%). Nearly two-thirds (11/17, 64.7%) reported SMART-AS helped them continue AS as a management strategy. Conclusions: This pilot study provides preliminary evidence supporting the feasibility and acceptability of SMART-AS among men with prostate cancer on AS. Participants reported perceived improvements in anxiety, coping, communication with clinicians, and self-management. Findings support further evaluation in a randomized controlled trial.