Lui Shiong Lee

Associate Professor Lee Lui Shiong is currently Head of Department, Department of Urology, Sengkang General Hospital, and a visiting senior consultant with National Cancer Centre Singapore. With a keen in interest in urologic-oncology, he spear-headed the development of a robotic cystectomy and intra-corporeal reconstruction service, alongside an Enhanced Recovery After Surgery programme and oversaw the development of a one-stop multi-disciplinary clinic with NCCS , catered to patients with advanced urological cancers with the intention of providing holistic care supported by evidence based practices. Beyond the MDT clinic, he maintains a strong interest in multi-visceral resection surgery such as pelvic exenterations and inferior venae-cavae thrombectomy. He also has strong collaborations with the GAP3 Global Consortium in Prostate Cancer Active Surveillance and the Asian Robotic Cystectomy Consortium. He has also held several research grants supporting investigator initiated trials and studies focused on urologic oncology. He has also led several award winning QI projects involving improving patient safety and clinical outcomes. For his efforts in pursuing better clinical outcomes through innovation, he was awarded the Singapore Health Quality Service Award 2024 in the Clinician Exemplar Leader category. As Site Director for the Singhealth Urology Residency Programme in Sengkang General Hospital, he oversees residency training and development and was recognised as an Outstanding Faculty Member in 2022. He is President of the Singapore Urological Association.

14th August 2025

Time Session
09:00
15:00
Asian Society of Urologic Oncology (ASUO)
  • Welcome Remarks
    Tai-Lung ChaTaiwan Speaker Novel Target for GU Cancer Metastasis and TherapeuticsCancer progression is shaped by both cell-intrinsic adaptations and complex extrinsic interactions within the tumor microenvironment (TME). Here, we identify a transmembrane protein, Meta1, as a shared therapeutic target that exhibits a Janus-like role: promoting malignant phenotypes in cancer cells while restraining tumor-supportive functions in non-cancerous stromal and immune cells. Meta1 is expressed in both compartments of the TME, orchestrating a dual program that supports metastasis and immune evasion. Mechanistically, we uncovered a malignancy-promoting factor (MPF) that acts as a functional ligand for Meta1, selectively enhancing pro-invasive signaling in cancer cells. We further identify Meta1 as an unconventional G protein–coupled receptor (GPCR) that plays as an accelerator in cancer cells of the TME. Meta1 interacts with Rho-GDI and Gαq to activate RhoA-mediated cytoskeletal remodeling and amoeboid migration, facilitating metastatic dissemination. We further identify MPF binding to Meta1 initiates Gβγ signaling, elevating intracellular cAMP and activating Rap1, thereby amplifying cell motility and metastatic potential. Leveraging the Meta1–MPF interaction, we designed MPF-derived peptides that specifically bind Meta1 and serve as the basis for a novel peptide-based PROTAC, which efficiently induces degradation of Meta1 and abrogates its pro-metastatic functions. Our study unveils Meta1 as an atypical GPCR with canonical signaling capacity and topological divergence, representing a shared and targetable vulnerability that bridges cancer cell-intrinsic adaptation with extrinsic TME communication. These findings establish the Meta1–MPF axis as a compelling therapeutic target for suppressing metastasis and reprogramming the TME.
  • Welcome Remarks
    Hong Gee SimSingapore Speaker
  • Bladder Cancer Track
    Edmund ChiongSingapore Moderator Debate: Bladder Preservation Should Be Considered for All Cases of MIBC
    Jacob See-Tong PangTaiwan Moderator
    Hanjong AhnKorea (Republic of) Moderator
  • MDT Discussion: Treating High-Risk BCG Refractory NMIBC in a ECOG2 75-year-old
    Po-Hung LinTaiwan Speaker Robotic Prostatectomy Using da Vinci SP SystemIn this semi-live section I will demonstrate the steps of extraperitoneal-approach radical prostatectomy using DAVINCI SP system.How to Make the Best Decision with Systemic Therapy Sequence in Respective of Genetic AnalysisRenal cell carcinoma (RCC) is a biologically heterogeneous disease driven by a limited set of convergent pathways that together shape oncogenesis, immune evasion, and therapeutic response. Across clear-cell RCC (ccRCC), recurrent alterations include VHL, PBRM1, BAP1, and SETD2, mapping onto five dominant axes: hypoxia signaling (VHL–HIF), PI3K/AKT/mTOR, chromatin remodeling, cell-cycle control, and metabolic rewiring. These lesions variably interact—e.g., mTORC1 enhances HIF translation—creating therapeutic opportunities (VEGF tyrosine-kinase inhibitors, HIF-2α inhibition, mTOR blockade) and constraints (adaptive resistance via metabolic plasticity). While immune checkpoint inhibitors (ICIs) and ICI–TKI combinations have improved outcomes in metastatic RCC, robust predictive biomarkers remain elusive. Tumor mutational burden is typically low and noninformative; PD-L1 shows assay- and context-dependent utility; PBRM1 and BAP1 are more prognostic than predictive. Emerging signals include angiogenic versus T-effector/myeloid transcriptional signatures, sarcomatoid/rhabdoid histology as a surrogate of immune-inflamed state, and host factors such as HLA genotype and gut microbiome composition. Liquid-biopsy modalities (ctDNA and methylome profiling) and spatial/single-cell atlases reveal intratumoral heterogeneity, T-cell exclusion niches, and myeloid programs (e.g., TREM2⁺ macrophages) linked to recurrence or ICI benefit. Early data support metabolism-targeted strategies (e.g., glutaminase inhibition) and rational combinations co-targeting angiogenesis, hypoxia signaling, and immune checkpoints; however, toxicity management and resistance evolution require prospective, biomarker-integrated trials. A clinical schema that pairs baseline multi-omic and microenvironmental profiling with adaptive surveillance (serial liquid biopsies, functional imaging) can lead to dynamically select among ICI–ICI, ICI–TKI, targeted, and experimental regimens. Robotic Prostatectomy Using da Vinci SP System
    Raj TiwariSingapore Speaker Practice Changing PapersPractice Changing Papers
  • Debate: Bladder Preservation Should Be Considered for All Cases of MIBC
    Jeremy TeohHong Kong, China Speaker Transurethral En Bloc Resection of Bladder Tumor: Where Are We Now?There is increasing evidence that transurethral en bloc resection of bladder tumour (ERBT) could lead to better peri-operative and oncological outcomes in patients with non-muscle-invasive bladder cancer. Modified approaches of ERBT have also been proposed to expand its indications for larger bladder tumours. The quality of resection is also the key for bladder-sparing treatment for muscle-invasive bladder cancer. We foresee an exciting journey ahead for ERBT, and as a urologist, we must embrace this novel technique for the best interest of our bladder cancer patients. To Publish or not to Publish? Navigating the path to academia in urologyDoing good science is the basis for technological advancement in healthcare. However, pursuing a path to academic in urology is often tough, stressful and frustrating. In this talk, I will share with you what I have learnt throughout my 15 years of research work. I will let you know what's the best and fastest way to become a globally renowned and successful researcher. Most importantly, I will explain what it takes to develop a great team and create a positive impact in people's lives. Believe in yourself! If I can do it, so can you.SIU Lecture: Role of MISTs in Male LUTS Surgical Management (Will TUR-P/ Laser Prostatectomy be Replaced?)Transurethral resection of prostate (TURP) is the current gold standard in treating patients with benign prostatic hyperplasia. Laser prostatectomy has also been used widely especially in patients who are on anticoagulants. However, both TURP and laser prostatectomy are associated with several problems including the need of spinal / general anaesthesia and the risk of male sexual dysfunction. In the past decade, we have witnessed the introduction of multiple new technologies including Rezum, Urolift, iTind and Aquablation. in this SIU lecture, we will discuss about the technical details, as well as the pros and cons of every new technology. We will also invite you to be our jury and decide whether TURP and laser prostatectomy will be replaced in the future. Novel Intravesical Therapeutics in the Evolving Landscape of NMIBCNon-muscle-invasive bladder cancer (NMIBC) is well known to be a difficult disease to manage, with a 1-year recurrence rate of up to 61% and 5-year recurrence rate of 78%. Despite the use of intravesical BCG therapy, NMIBC patients may still experience recurrence and develop what we call BCG-unresponsive NMIBC. Conventionally, we offer upfront radical cystectomy for patients with BCG-unresponsive NMIBC, however, this is an ultra-major surgery with significant risk of complications and could also lead to significant deterioration in quality of life in the long run. We are in urgent need for novel therapies to manage this difficult condition. In this lecture, we will discuss the evidence on the different novel intravesical therapies in treating BCG-unresponsive NMIBC. SIU Lecture: Role of MISTs in Male LUTS Surgical Management (Will TUR-P/ Laser Prostatectomy be Replaced?)
    Tuan Thanh NguyenVietnam Speaker Debate: Bladder Preservation Should Be Considered for All Cases of MIBCPractice Changing Papers
    Edmund ChiongSingapore Speaker Debate: Bladder Preservation Should Be Considered for All Cases of MIBC
  • Technical Pearls: Node Dissection in Robotic Cystectomy
    Noor Ashani Md YusoffMalaysia Speaker Technical Pearls: Node Dissection in Robotic CystectomyHighlight and Limitation in Urology Service in MalaysiaRobotic Pelvic LN Dissection: A critical Component of Bladder Cancer Surgery
  • Technical Pearls: Robotic Intra-Corporeal OBS
    Lui Shiong LeeSingapore Speaker Technical Pearls: Robotic Intra-Corporeal OBSThis session will demonstrate the key steps required in the intra-corporeal creation of a Studer type orthotropic bladder substitute.
  • Practice Changing Papers
    Bhoj Raj LuitelNepal Speaker Practice Changing Papers
  • Coffee Break
  • Prostate Cancer Track
    Teng-Aik OngMalaysia Moderator
    Bannakij LojanapiwatThailand Moderator PSA Kinetics Following PADT in mHSPC. Is It a Real-World Tool for Predicting Oncologic Outcome?PSA Kinetics following Primary Androgen Deprivation Therapy (PADT) in mHSPC. Is it a Real-world Tool for Prediction Oncologic Outcome? Bannakij Lojanapiwat, M.D. Professor of Urology, Chiang Mai University, Thailand. Of recent guidelines, upfront primary androgen deprivation monotherapy or combination therapy (PADT) is recommended for the treatment of metastatic hormone sensitive prostate cancer (mHSPC). Limitation of real-world treatment such as culture difference, financial barrier, geographic access to treatment and high operation/ radiation risks associated with medical comorbidity led to underutilization of combination therapy as the standard guideline. Prognostic factors are important in clinical practice which can predict the clinical outcome that offer the pre-treatment counseling for patients to select the optimal treatment. Prostate specific antigen (PSA) levels is one of the important key prognostic markers. PSA kinetics of nadir PSA level and time to nadir PSA following the treatment are the important role for progression to CRPC and oncologic outcome. Our study and the previous studies reported better oncologic outcome especially overall survival, cancer specific survival and time to developed CRPC in mHSPC patients received upfront PADT who decline PSA≥95% (deep responder), PSA nadir ≤ 0.2 ng/ml (low PSA nadir level), time to PSA nadir ≥ 6 month and PSA decline velocity <11 ng/ml/month. PSA Kinetics following Primary Androgen Deprivation Therapy (PADT) is one of a real-world tool for prediction oncologic outcome in the treatment of mHSPC.
    Sunil KimKorea (Republic of) Moderator
  • MDT Discussion: Personalizing Treatment in High Volume CSPC
    Winnie LamSingapore Speaker MDT Discussion: Personalizing Treatment in High Volume CSPC
    Chao-Yuan HuangTaiwan Speaker MDT Discussion: Personalizing Treatment in High Volume CSPC
    Peter Ka-Fung ChiuHong Kong, China Speaker Minimal Invasive Therapy: Where do We Stand in 2025Endourological, Laparoscopic and robotic surgeries have replaced most open surgeries in Urology. Emergence of new robotic platforms have provided urologists with new opportunities. Both boom-type and module-type robots have been used, and they each have their strengths in practice. Tele-surgeries have provided a new paradigm of long-distance robotic surgeries to facilitate new surgical possibilities and proctorship. State of the art robotic surgeries in retrograde intrarenal surgeries and enbloc resection MDT Discussion: Personalizing Treatment in High Volume CSPCN/ADebate: Should We Only Offer Consolidative Cytoreductive Nephrectomy in Metastatic RCC?N/AFocal Therapy in Asia – Is It Prime Time?The increase in incidence of Prostate cancer has been rapid in Asia in the past 10 years. While Robotic radical prostatectomy and Radiotherapy has been the commonest treatments for localized prostate cancer, significant long-term morbidities are observed after surgery or radiotherapy including incontinence, erectile dysfunction and irradiation injury to the bladder and rectum. In the current era of MRI-guided prostate biopsy, focal diseases can be targeted and diagnosed, and image-guided focal therapy emerged as an alternative treatment. Although Focal therapy has a relatively higher rate of local recurrence, it has the advantages of minimal or no long-term complication after treatment, and it is possible to perform retreatment with focal therapy, prostatectomy or radiotherapy. In properly selected patients, the need for salvage prostatectomy or radiotherapy after focal therapy is less than 20% at 8 years, and patients’ quality of life could be preserved. In well-selected patients, focal therapy is an attractive option. Current focal therapy for prostate cancer available in Asia includes HIFU, Cryotherapy, Targeted Microwave Ablation (TMA), irreversible electroporation (IRE) and TULSA.
  • Debate: PIRADS 4/5 Negative Biopsies Should
    Enrique Ian LorenzoPhilippines Speaker Debate: PIRADS 4/5 Negative Biopsies ShouldDebate: Should We Only Offer Consolidative Cytoreductive Nephrectomy in Metastatic RCC?
    Kenneth ChenSingapore Speaker Debate: PIRADS 4/5 Negative Biopsies Should
  • Technical Pearls: Retzius Sparing
    Tanet ThaidumrongThailand Speaker Technical Pearls: Retzius SparingTreating SRM in a 65-Year-Old ECOG 1 with Multiple Previous Operations-Is Minimally Invasive Treatment Feasible?
  • Technical Pearls: Nerve-Sparing
    Hung-Jen WangTaiwan Speaker Technical Pearls: Nerve-SparingPreserving the neurovascular bundles (NVB) during robotic-assisted radical prostatectomy (RARP) is crucial for maintaining postoperative continence and sexual function, while still ensuring complete cancer removal. We will share "technical pearls" for nerve-sparing in RARP, emphasizing practical innovations that enhance surgical precision without compromising oncologic control. Retrograde nerve-sparing involves a bottom-up (apex-to-base) dissection of the NVB using an athermal, gentle approach. This technique, adapted from open surgery, allows early identification and release of the nerves under direct vision. By minimizing traction and avoiding cautery near the NVB, it reduces inadvertent nerve injury and even lowers the risk of positive margins at the prostatic base. Clinically, adopting a retrograde approach (often with 30° lens “toggling”) has been linked to faster functional recovery of potency, contributing to potency rates approaching 90% at 1 year in fully nerve-sparing cases. Parallel advances in augmented reality (AR) are providing real-time surgical navigation. AR technology superimposes 3D virtual models (e.g. from MRI) onto the operative field, enhancing visualization of patient-specific anatomy. Surgeons can pinpoint tumor location relative to the NVB, enabling selective, confidence-guided nerve preservation even in locally advanced disease. This approach helps modulate nerve-sparing extent on a case-by-case basis, maintaining oncologic safety (low positive surgical margin rates) while maximizing nerve preservation. Finally, refined anatomical landmarks have emerged to guide nerve-sparing. A notable example is the identification of a consistent small arterial branch (“landmark artery”) at the NVB’s medial aspect. This vessel serves as a guide for partial nerve-sparing: dissecting just lateral to it yields an approximate 3 mm tissue margin from the prostatic capsule, sufficient to clear potential extracapsular extension while preserving the remaining nerve fibers. Such landmark-oriented dissection provides a reproducible framework for tailoring nerve-sparing to tumor risk, moving beyond the traditional “all-or-none” approach. These advanced techniques and concepts are empowering robotic surgeons to achieve optimal outcomes. By integrating retrograde nerve-sparing, AR-assisted navigation, and anatomical landmark guidance, one can improve early continence recovery and postoperative sexual function for patients without sacrificing cancer control.
  • Technical Pearls: Total Extraperitoneal Technique
    John YuenSingapore Speaker Technical Pearls: Total Extraperitoneal TechniquePractice-Changing Development in RaLRP
  • Practice Changing Papers
    Raj TiwariSingapore Speaker Practice Changing PapersPractice Changing Papers
  • Group Photo
  • Lunch Break
  • Kidney Cancer Track
    John YuenSingapore Moderator Technical Pearls: Total Extraperitoneal TechniquePractice-Changing Development in RaLRP
    Agus Rizal HamidIndonesia Moderator
  • Treating SRM in a 65-Year-Old ECOG 1 with Multiple Previous Operations-Is Minimally Invasive Treatment Feasible?
    Tanet ThaidumrongThailand Speaker Technical Pearls: Retzius SparingTreating SRM in a 65-Year-Old ECOG 1 with Multiple Previous Operations-Is Minimally Invasive Treatment Feasible?
  • Treating SRM in a 65-Year-Old ECOG 1 with Multiple Previous Operations-Is SBRT the New Kid on the Block?
    Jeffrey TuanSingapore Speaker Treating SRM in a 65-Year-Old ECOG 1 with Multiple Previous Operations-Is SBRT the New Kid on the Block?The management of small renal masses (SRMs) in older adults with prior surgical histories remains complex, particularly in patients with limited physiological reserve and increased perioperative risk. We present the case of a 65-year-old patient with an ECOG performance status of 1 and multiple prior abdominal surgeries, highlighting the challenges of repeated surgical intervention and the evolving role of stereotactic body radiotherapy (SBRT) as a non-invasive alternative. SBRT offers ablative doses of radiation with sub-millimeter precision, enabling tumor control while preserving renal function and minimizing treatment-related morbidity. Emerging data support its safety and efficacy in medically inoperable patients or those at high surgical risk. This case underscores the need to reconsider SBRT as a frontline therapeutic option in selected patients with SRM, particularly when traditional surgical or ablative approaches are contraindicated or carry significant risk. Further prospective studies are warranted to define optimal patient selection and long-term outcomes
  • Debate: Should We Only Offer Consolidative Cytoreductive Nephrectomy in Metastatic RCC?
    Enrique Ian LorenzoPhilippines Speaker Debate: PIRADS 4/5 Negative Biopsies ShouldDebate: Should We Only Offer Consolidative Cytoreductive Nephrectomy in Metastatic RCC?
    Peter Ka-Fung ChiuHong Kong, China Speaker Minimal Invasive Therapy: Where do We Stand in 2025Endourological, Laparoscopic and robotic surgeries have replaced most open surgeries in Urology. Emergence of new robotic platforms have provided urologists with new opportunities. Both boom-type and module-type robots have been used, and they each have their strengths in practice. Tele-surgeries have provided a new paradigm of long-distance robotic surgeries to facilitate new surgical possibilities and proctorship. State of the art robotic surgeries in retrograde intrarenal surgeries and enbloc resection MDT Discussion: Personalizing Treatment in High Volume CSPCN/ADebate: Should We Only Offer Consolidative Cytoreductive Nephrectomy in Metastatic RCC?N/AFocal Therapy in Asia – Is It Prime Time?The increase in incidence of Prostate cancer has been rapid in Asia in the past 10 years. While Robotic radical prostatectomy and Radiotherapy has been the commonest treatments for localized prostate cancer, significant long-term morbidities are observed after surgery or radiotherapy including incontinence, erectile dysfunction and irradiation injury to the bladder and rectum. In the current era of MRI-guided prostate biopsy, focal diseases can be targeted and diagnosed, and image-guided focal therapy emerged as an alternative treatment. Although Focal therapy has a relatively higher rate of local recurrence, it has the advantages of minimal or no long-term complication after treatment, and it is possible to perform retreatment with focal therapy, prostatectomy or radiotherapy. In properly selected patients, the need for salvage prostatectomy or radiotherapy after focal therapy is less than 20% at 8 years, and patients’ quality of life could be preserved. In well-selected patients, focal therapy is an attractive option. Current focal therapy for prostate cancer available in Asia includes HIFU, Cryotherapy, Targeted Microwave Ablation (TMA), irreversible electroporation (IRE) and TULSA.
  • Technical Pearls: Wheel-Barrow Techniques
    Henry HoSingapore Speaker Technical Pearls: Wheel-Barrow TechniquesBringing Innovation to PatientRobotic Partial Nephrectomy: Beyond Technique
  • Technical Pearls: Renorrhaphy Techniques
    Vorapot Choonhaklai Thailand Speaker Technical Pearls: Renorrhaphy Techniques
  • Practice Changing Papers
    Tuan Thanh NguyenVietnam Speaker Debate: Bladder Preservation Should Be Considered for All Cases of MIBCPractice Changing Papers
  • Closing Remarks
    Lui Shiong LeeSingapore Speaker Technical Pearls: Robotic Intra-Corporeal OBSThis session will demonstrate the key steps required in the intra-corporeal creation of a Studer type orthotropic bladder substitute.
TICC - 1F 101A

15th August 2025

Time Session
15:30
17:00
Oncology 2
Prostate Cancer
  • Prostate Cancer
    Kai-Jie YuTaiwan Moderator
    Lui Shiong LeeSingapore Moderator Technical Pearls: Robotic Intra-Corporeal OBSThis session will demonstrate the key steps required in the intra-corporeal creation of a Studer type orthotropic bladder substitute.
  • Focal Therapy in Asia – Is It Prime Time?
    Peter Ka-Fung ChiuHong Kong, China Speaker Minimal Invasive Therapy: Where do We Stand in 2025Endourological, Laparoscopic and robotic surgeries have replaced most open surgeries in Urology. Emergence of new robotic platforms have provided urologists with new opportunities. Both boom-type and module-type robots have been used, and they each have their strengths in practice. Tele-surgeries have provided a new paradigm of long-distance robotic surgeries to facilitate new surgical possibilities and proctorship. State of the art robotic surgeries in retrograde intrarenal surgeries and enbloc resection MDT Discussion: Personalizing Treatment in High Volume CSPCN/ADebate: Should We Only Offer Consolidative Cytoreductive Nephrectomy in Metastatic RCC?N/AFocal Therapy in Asia – Is It Prime Time?The increase in incidence of Prostate cancer has been rapid in Asia in the past 10 years. While Robotic radical prostatectomy and Radiotherapy has been the commonest treatments for localized prostate cancer, significant long-term morbidities are observed after surgery or radiotherapy including incontinence, erectile dysfunction and irradiation injury to the bladder and rectum. In the current era of MRI-guided prostate biopsy, focal diseases can be targeted and diagnosed, and image-guided focal therapy emerged as an alternative treatment. Although Focal therapy has a relatively higher rate of local recurrence, it has the advantages of minimal or no long-term complication after treatment, and it is possible to perform retreatment with focal therapy, prostatectomy or radiotherapy. In properly selected patients, the need for salvage prostatectomy or radiotherapy after focal therapy is less than 20% at 8 years, and patients’ quality of life could be preserved. In well-selected patients, focal therapy is an attractive option. Current focal therapy for prostate cancer available in Asia includes HIFU, Cryotherapy, Targeted Microwave Ablation (TMA), irreversible electroporation (IRE) and TULSA.
  • Primary Radical Prostatectomy in Low Volume Metastatic Prostate Cancer
    Zainal Adwin Zainal AbiddinMalaysia Speaker Primary Radical Prostatectomy in Low Volume Metastatic Prostate Cancer
  • Risk Stratification and Contemporary Management of Biochemical Recurrence
    Stephen A. BoorjianUnited States Speaker AUA Lecture: 2025 Update of AUA and EAU NMIBC GuidelinesBoth the American Urological Association (AUA) and European Association of Urology (EAU) have developed guidelines for the management of non-muscle invasive bladder cancer (NMIBC). While subtle differences in several aspects of these guidelines exist which merit mentioning, both guidelines emphasis the concept of risk stratification. In particular, understanding the criteria which classifies patients with NMIBC as high risk avoids undertreatment of the patients most likely to experience disease progress. Likewise, recognizing the indications for cystectomy among high risk NMIBC patients is critical to optimize survival. Meanwhile, continued options emerge for patients classified as having BCG unresponsive NMIBC, such that knowledge of that definition as well as current management strategies for these patients facilitates contemporary practice.From Bench to Bedside - A Comprehensive Overview of Kidney CancerEvaluation of patients with a newly identified renal mass includes dedicated cross-sectional imaging for appropriate characterization. Genetic syndromes which include renal cell carcinoma (RCC) are increasingly understood, and indeed knowledge of the intracellular pathways of these conditions has facilitate rationale drug development for kidney cancer. Managing patients with a small renal mass involves a critical assessment of competing risks inherent to the tumor, the patient (underlying comorbidity status), and the proposed treatment. Renal mass biopsy may play a role in select cases for additional information/risk stratification. The safety of active surveillance is being increasingly demonstrated as longer-term follow-up matures. Meanwhile, select patients with high risk disease now have the option of adjuvant immunotherapy following surgical resection. In the setting of metastatic RCC, again risk stratification plays a critical role in the decision for – and timing of – cytoreductive nephrectomy, particularly in the contemporary era of checkpoint inhibitor therapies.Real World Experience in the Management of Upper Tract Urothelial CarcinomaThe biggest challenging in managing upper tract urothelial carcionma (UTUC) remains accurate staging of tumors at diagnosis. Given the limited ability of contemporary staging methods, clinical risk stratification models have been developed to assist in providing risk-based treatment recommendations. For example, endoscopic management (e.g., ablation) represents the recommended first line approach for patients with low risk disease. Importantly, follow-up for these patients should include endoscopic re-evaluation. The value of testing patients with UTUC for Lynch syndrome is also critical to recognize. A role for neoadjuvant chemotherapy is being increasing explored for patients classified with high-risk UTUC, while several options exist for adjuvant chemotherapy and immunotherapy for patients with adverse pathology at surgical resection. Continued investigation into prevention of postoperative intravesical recurrences in patients with UTUC is warranted given the frequency of metachronous tumor development in the bladder among these patients.Updates on MIBC and Advanced Bladder Cancer: Where do We Stand in 2025While neoadjuvant chemotherapy prior to radical cystectomy has been demonstrated with randomized trial data to improve survival for patients undergoing radical cystectomy, nevertheless utilization is often restricted by misunderstandings regarding patient eligibility factors. As such, defining eligibility criteria will facilitate increased adoption. Likewise, new data indicates a role for adjust immunotherapy in select patients following surgery as well. Moreover, important recent evidence on the role of extended lymph node dissection and the opportunities for preserving sexual function after cystectomy by modifying surgical technique are critical to review in order to optimize future patient outcomes. Further, recent advancements in systemic therapy options for patients with metastatic urothelial carcinoma have led to unprecedented survival rates.Revisit on Testicular Tumors-What we Learned from past and Prepared for the FutureGerm cell tumor (GCT) progression typically occurs in a predictable sequence of disease spread to the retroperitoneum first and then distant metastases. Understanding the role of serum tumor markers at various disease stages is critical for guideline-concordant management and to optimize patient outcomes, avoiding both undertreatment and overtreatment. For patients with seminoma, retroperitoneal lymph node dissection now represents an option for patients with low volume retroperitoneal lymph node disease, with the goal of avoiding the long-term toxicities associated with chemotherapy and radiotherapy. For patients with residual postchemotherapy masses in seminoma, increasing evidence suggests that PET scans should be utilized/interpreted with caution, and that in the absence of mass growth continued follow-up may be the strategy for most patients. Similarly, for patients with nonseminomatous GCTs (NSGCT) and equivocal retroperitoneal lymph nodes at presentation, re-scanning after an interval of approximately 6-8 weeks may be preferable to initial treatment, as many of these nodes represent benign processes and as such will resolve. Nevertheless, postchemotherapy retroperitoneal lymph node dissection remains a critical component of the management of patients with NSCGT and a residual mass. Risk Stratification and Contemporary Management of Biochemical RecurrenceBiochemical recurrence (BCR) has been reported in up to 35% of patients following radical prostatectomy. Understanding the natural history and clinicopathologic risk factors associated with disease progression is critical to facilitate an individualized treatment approach. Likewise, recognizing the details of treatment delivery with salvage radiotherapy is necessary to optimize outcomes. Further, as data emerge on the utilization of systemic therapy for non-metastatic BCR, being able to contextualize reported outcomes with patient age, comorbidity status, and disease risk will enhance appropriate care delivery.
  • The Strategy to Initiate PSMA-Based Therapies for Advanced Prostate Cancer
    Ching-Chu LuTaiwan Speaker The Strategy to Initiate PSMA-Based Therapies for Advanced Prostate CancerPSMA-targeted radioligand therapy (PSMA RLT) has emerged as a promising treatment for metastatic castration-resistant prostate cancer (mCRPC), particularly after failure of androgen deprivation therapy, next-generation hormonal agents, and chemotherapy. While PSMA RLT is currently a third-line treatment, evidence from the PSMAfore trial suggests its potential efficacy when used earlier in the treatment sequence, prior to chemotherapy, offering a new strategy for improving progression-free survival (PFS) in mCRPC patients. In addition, PSMA RLT is being explored in metastatic hormone-sensitive prostate cancer (mHSPC), with ongoing trials such as PSMAddition, investigating its role in delaying disease progression and improving patient outcomes when combined with standard therapies. Moreover, PSMA RLT is being evaluated in combination with other treatments, including PARP inhibitors, immunotherapy, chemotherapy, and radiation therapy. Numerous ongoing trials are exploring these combination therapies to further enhance the therapeutic efficacy of PSMA RLT and improve patient outcomes in advanced prostate cancer. Novel radionuclides such as Actinium-225 (Ac-225) and Terbium-161 (Tb-161) are being investigated for their potential to improve the therapeutic profile of PSMA RLT. These isotopes offer unique advantages, including different radiation characteristics that could increase the efficacy and safety of PSMA-targeted therapies. In conclusion, PSMA RLT is becoming a cornerstone of precision oncology for prostate cancer. As research continues to explore its use earlier in the treatment continuum, in combination with other therapies, and with the incorporation of novel radionuclides, PSMA RLT holds great promise for improving outcomes in advanced prostate cancer patients.
  • Discussion
TICC - 2F 201BC

17th August 2025

Time Session
08:30
10:00
Plenary Session 6
  • Impact of Relugolix versus Leuprolide on the Quality of Life of Men with Advanced Prostate Cancer: Results from the Phase 3 HERO Study (European Urology, 2023)
    Tai-Lung ChaTaiwan Moderator Novel Target for GU Cancer Metastasis and TherapeuticsCancer progression is shaped by both cell-intrinsic adaptations and complex extrinsic interactions within the tumor microenvironment (TME). Here, we identify a transmembrane protein, Meta1, as a shared therapeutic target that exhibits a Janus-like role: promoting malignant phenotypes in cancer cells while restraining tumor-supportive functions in non-cancerous stromal and immune cells. Meta1 is expressed in both compartments of the TME, orchestrating a dual program that supports metastasis and immune evasion. Mechanistically, we uncovered a malignancy-promoting factor (MPF) that acts as a functional ligand for Meta1, selectively enhancing pro-invasive signaling in cancer cells. We further identify Meta1 as an unconventional G protein–coupled receptor (GPCR) that plays as an accelerator in cancer cells of the TME. Meta1 interacts with Rho-GDI and Gαq to activate RhoA-mediated cytoskeletal remodeling and amoeboid migration, facilitating metastatic dissemination. We further identify MPF binding to Meta1 initiates Gβγ signaling, elevating intracellular cAMP and activating Rap1, thereby amplifying cell motility and metastatic potential. Leveraging the Meta1–MPF interaction, we designed MPF-derived peptides that specifically bind Meta1 and serve as the basis for a novel peptide-based PROTAC, which efficiently induces degradation of Meta1 and abrogates its pro-metastatic functions. Our study unveils Meta1 as an atypical GPCR with canonical signaling capacity and topological divergence, representing a shared and targetable vulnerability that bridges cancer cell-intrinsic adaptation with extrinsic TME communication. These findings establish the Meta1–MPF axis as a compelling therapeutic target for suppressing metastasis and reprogramming the TME.
    Bertrand TombalBelgium Speaker Impact of Relugolix versus Leuprolide on the Quality of Life of Men with Advanced Prostate Cancer: Results from the Phase 3 HERO Study (European Urology, 2023)
  • SIU Lecture: Role of MISTs in Male LUTS Surgical Management (Will TUR-P/ Laser Prostatectomy be Replaced?)
    Rohan MalekMalaysia Moderator
    Jeremy TeohHong Kong, China Speaker Transurethral En Bloc Resection of Bladder Tumor: Where Are We Now?There is increasing evidence that transurethral en bloc resection of bladder tumour (ERBT) could lead to better peri-operative and oncological outcomes in patients with non-muscle-invasive bladder cancer. Modified approaches of ERBT have also been proposed to expand its indications for larger bladder tumours. The quality of resection is also the key for bladder-sparing treatment for muscle-invasive bladder cancer. We foresee an exciting journey ahead for ERBT, and as a urologist, we must embrace this novel technique for the best interest of our bladder cancer patients. To Publish or not to Publish? Navigating the path to academia in urologyDoing good science is the basis for technological advancement in healthcare. However, pursuing a path to academic in urology is often tough, stressful and frustrating. In this talk, I will share with you what I have learnt throughout my 15 years of research work. I will let you know what's the best and fastest way to become a globally renowned and successful researcher. Most importantly, I will explain what it takes to develop a great team and create a positive impact in people's lives. Believe in yourself! If I can do it, so can you.SIU Lecture: Role of MISTs in Male LUTS Surgical Management (Will TUR-P/ Laser Prostatectomy be Replaced?)Transurethral resection of prostate (TURP) is the current gold standard in treating patients with benign prostatic hyperplasia. Laser prostatectomy has also been used widely especially in patients who are on anticoagulants. However, both TURP and laser prostatectomy are associated with several problems including the need of spinal / general anaesthesia and the risk of male sexual dysfunction. In the past decade, we have witnessed the introduction of multiple new technologies including Rezum, Urolift, iTind and Aquablation. in this SIU lecture, we will discuss about the technical details, as well as the pros and cons of every new technology. We will also invite you to be our jury and decide whether TURP and laser prostatectomy will be replaced in the future. Novel Intravesical Therapeutics in the Evolving Landscape of NMIBCNon-muscle-invasive bladder cancer (NMIBC) is well known to be a difficult disease to manage, with a 1-year recurrence rate of up to 61% and 5-year recurrence rate of 78%. Despite the use of intravesical BCG therapy, NMIBC patients may still experience recurrence and develop what we call BCG-unresponsive NMIBC. Conventionally, we offer upfront radical cystectomy for patients with BCG-unresponsive NMIBC, however, this is an ultra-major surgery with significant risk of complications and could also lead to significant deterioration in quality of life in the long run. We are in urgent need for novel therapies to manage this difficult condition. In this lecture, we will discuss the evidence on the different novel intravesical therapies in treating BCG-unresponsive NMIBC. SIU Lecture: Role of MISTs in Male LUTS Surgical Management (Will TUR-P/ Laser Prostatectomy be Replaced?)
  • Updates on Molecular Classification and Diagnostics of Upper Urinary Tract Urothelial Carcinoma
    Pukar MaskeyNepal Moderator
    Haruki KumeJapan Speaker Updates on Molecular Classification and Diagnostics of Upper Urinary Tract Urothelial CarcinomaUpper urinary tract urothelial carcinoma (UTUC) is a relatively common form of urothelial cancer. However, the molecular mechanisms underlying its carcinogenesis and progression have not been well understood. Most urologists previously believed that the mutational profiles of UTUC and urothelial bladder carcinoma (UBC) were similar. In 2021, by analyzing 198 cases of upper urinary tract cancer, we identified five distinct molecular subtypes of UTUC, each characterized by unique gene expression patterns, tumor locations/histology, and clinical outcomes: hypermutated, TP53/MDM2, RAS, FGFR3, and triple-negative subtypes. Notably, the hypermutated subtype, accounting for approximately 5% of all cases, was predominantly associated with Lynch syndrome, aligning with previous reports. In contrast, UBC is known to be rarely linked to Lynch syndrome. In this plenary session, I will delve into the molecular pathogenesis of UTUC and discuss future perspectives in this field.
  • A Fully Automated Artificial Intelligence System to Assist Pathologists' Diagnosis to Predict Histologically High-Grade Urothelial Carcinoma from Digitized Urine Cytology
    John Jang Hwan KimKorea (Republic of) Moderator
    Osamu UkimuraJapan Speaker A Fully Automated Artificial Intelligence System to Assist Pathologists' Diagnosis to Predict Histologically High-Grade Urothelial Carcinoma from Digitized Urine CytologyBackground: Urine cytology, although a useful screening method for urothelial carcinoma, lacks sensitivity. As an emerging technology, artificial intelligence (AI) improved image analysis accuracy significantly. Objective: To develop a fully automated AI system to assist pathologists in the histological prediction of high-grade urothelial carcinoma (HGUC) from digitized urine cytology slides. Design, setting, and participants: We digitized 535 consecutive urine cytology slides for AI use. Among these slides, 181 were used for AI development, 39 were used as AI test data to identify HGUC by cell-level classification, and 315 were used as AI test data for slide-level classification. Outcome measurements and statistical analysis: Out of the 315 slides, 171 were collected immediately prior to bladder biopsy or transurethral resection of bladder tumor, and then outcomes were compared with the histological presence of HGUC in the surgical specimen. The primary aim was to compare AI prediction of the histological presence of HGUC with the pathologist's histological diagnosis of HGUC. Secondary aims were to compare the time required for AI evaluation and concordance between the AI's classification and pathologist's cytology diagnosis. Results and limitations: The AI capability for predicting the histological presence of HGUC was 0.78 for the area under the curve. Comparing the AI predictive performance with pathologists' diagnosis, the AI sensitivity of 63% for histological HGUC prediction was superior to a pathologists' cytology sensitivity of 46% (p = 0.0037). On the contrary, there was no significant difference between the AI specificity of 83% and pathologists' specificity of 89% (p = 0.13), and AI accuracy of 74% and pathologists' accuracy of 68% (p = 0.08). The time required for AI evaluation was 139 s. With respect to the concordance between the AI prediction and pathologist's cytology diagnosis, the accuracy was 86%. Agreements with positive and negative findings were 92% and 84%, respectively. Conclusions: We developed a fully automated AI system to assist pathologists' histological diagnosis of HGUC using digitized slides. This AI system showed significantly higher sensitivity than a board-certified cytopathologist and may assist pathologists in making urine cytology diagnoses, reducing their workload. Patient summary: In this study, we present a deep learning-based artificial intelligence (AI) system that classifies urine cytology slides according to the Paris system. An automated AI system was developed and validated with 535 consecutive urine cytology slides. The AI predicted histological high-grade urothelial carcinoma from digitized urine cytology slides with superior sensitivity than pathologists, while maintaining comparable specificity and accuracy. Keywords: Artificial intelligence; Deep learning; The Paris System; Urine cytology; Urothelial carcinoma.
  • Recommendations in Laser Use for the Treatment of Upper Tract Urothelial Carcinoma
    Bou SopheapCambodia Moderator
    Athanasios PapatsorisGreece Speaker BCG Refractory Cancer: Current Status of Intravesical TreatmentRecommendations in Laser Use for the Treatment of Upper Tract Urothelial Carcinoma
  • UTUC Treatment — Evidence & Guideline Recommendation
    Lui Shiong LeeSingapore Moderator Technical Pearls: Robotic Intra-Corporeal OBSThis session will demonstrate the key steps required in the intra-corporeal creation of a Studer type orthotropic bladder substitute.
    Yuki EndoJapan Speaker UTUC Treatment — Evidence & Guideline Recommendation "Current Status and Future Perspectives of Robot-Assisted Nephroureterectomy (RNU) in the Treatment of Upper Tract Urothelial Carcinoma (UTUC): Evidence and Guideline Recommendations" The standard treatment for upper tract urothelial carcinoma (UTUC) is surgical therapy. With the advancement of robot-assisted surgery, robotic procedures have become widespread in both upper and lower urinary tracts. In Japan, robot-assisted laparoscopic nephroureterectomy (RNU) for UTUC was included in health insurance coverage in 2019, and the proportion of RNUs for UTUC treatment is expected to increase. RNU, supported by robotic assistance, enables minimally invasive and precise procedures, allowing for reduced postoperative complications and shorter recovery periods (O'Sullivan et al., BJUI Compass. 2023). With further accumulation of data from randomized prospective trials and long-term follow-up studies, improvements in therapeutic outcomes, such as reduced postoperative recurrence, are anticipated. However, as a new technology, there is currently no established evidence. In a notable study, the only prospective randomized trial comparing laparoscopic nephroureterectomy (LNU) with open nephroureterectomy (ONU) showed no difference in disease-specific survival overall. However, in the pT3 or higher group, disease-specific survival and metastasis-free survival were significantly lower in the LNU group (Simone G et al., Eur Urol, 2009). Based on these results, both the European Association of Urology (EAU) guidelines and the Japanese Urological Association (JUA) guidelines recommend ONU for cT3 or higher stages. In addition, drug therapies, including immune checkpoint inhibitors (ICIs) and antibody-drug conjugates (ADCs), are rapidly advancing, and reports of new clinical trials combining these therapies are changing the surgical strategies for MIUC. I would like to review the current positioning of RNU in each guideline and discuss cancer control points when performing RNU, which is expected to become more widespread, with the latest evidence.
TICC - 3F Banquet Hall