Cardiovascular complications increasingly challenge survivors of urological cancers, given the cardiotoxicity of therapies such as androgen deprivation, vascular endothelial growth factor receptor inhibitors, tyrosine kinase inhibitors, immune checkpoint inhibitors, and chemotherapy. This narrative review addresses the complex crosstalk between urological cancer treatment and cardiovascular disease. It summarizes cardiovascular toxicities linked to major antineoplastic agents, explores underlying mechanisms including metabolic and immune-mediated effects, and proposes strategies for surveillance, diagnosis, and management. Highlighting the need for multidisciplinary collaboration, it outlines future directions for research to optimize cardiovascular outcomes in this high-risk population. The increasing complexity of cardiovascular care in patients with urological malignancies highlights the need for closer collaboration between cardiologists, urologists, and oncologists, with uro-cardio-oncology emerging as an important multidisciplinary field.

Background/Objectives : Cancer-associated thrombosis (CAT) increases morbidity and mortality in cancer patients. To describe CAT in urological malignancies and explore associated factors, timing, Khorana score performance and systemic inflammatory indices. Methods: This retrospective study included 1044 patients. Oncological, cardiovascular and laboratory data from medical records were compared by CAT status. Firth penalized logistic regression was used for sparse-event analyses. Results: Thirty-one patients (2.97%) developed CAT, including 17 arterial thrombotic events (ATE) and 14 venous thromboembolic events (VTE). Advanced stage was associated with CAT (adjusted odds ratio [aOR] per stage 1.60, 95% confidence interval [CI] 1.21–2.17; p < 0.001) in the primary and sensitivity analyses. In an exploratory analysis, cardiovascular disease was associated with ATE (odds ratio [OR] 4.58, 95% CI 1.67–15.16; Benjamini–Hochberg [BH]-adjusted q = 0.031), although the small number of ATE precluded a reliable subgroup conclusion. Median time from cancer diagnosis to CAT was 3 months. The Khorana score did not show useful VTE discrimination in the systemic chemotherapy subgroup (77 patients; four VTE; area under the receiver operating characteristic curve [AUC] 0.437, 95% CI 0.127–0.746). The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic inflammation response index (SIRI), and systemic immune-inflammation index (SII) showed no useful discrimination (AUCs 0.487–0.513) or improvement of the clinical model (all BH-adjusted q = 0.963). Conclusions: Advanced stage was the most consistent correlate of CAT. Arterial and venous events occurred in similar proportions and were concentrated early after diagnosis. Exploratory analyses suggested a possible relationship between cardiovascular disease and ATE, whereas the Khorana findings were inconclusive and the inflammatory indices lacked discriminatory value. Larger prospective studies are needed to confirm these findings.