Félix Guerrero-Ramos | Oncologic Urology Unit Coordinator, Department of Urology, Hospital Universitario 12 de Octubre, Madrid; Co-founder, Danae Urogenomics, Madrid, Spain
Citation: EMJ Oncol. 2026; https://doi.org/10.33590/emjoncol/4K1F7RED
What first drew you to uro-oncology and, specifically, bladder cancer?
What attracted me to uro-oncology was the combination of technically demanding surgery, complex decision-making, and the opportunity to build long-term relationships with patients. Within uro-oncology, bladder cancer has always stood out because it is an incredibly heterogeneous disease. Two patients may share the same diagnosis but require completely different treatment strategies, ranging from endoscopic management to radical surgery or systemic/intravesical therapies. Over the last decade, bladder cancer has undergone one of the most remarkable transformations in oncology. We have moved from having relatively limited treatment options to an era of immunotherapy, antibody–drug conjugates, gene therapy, novel intravesical agents, and increasingly personalised approaches. Being involved in that evolution, both as a clinician and as a researcher, is extremely rewarding.
Your research focuses heavily on bladder cancer. Could you talk us through the current treatment landscape and how it is evolving?
The treatment landscape is evolving at an unprecedented pace. For decades, Bacillus Calmette-Guérin therapy remained essentially the only effective intravesical therapy for high-risk non-muscle-invasive bladder cancer. Today, we are witnessing the arrival of multiple new therapeutic strategies, including immune checkpoint inhibitors, gene therapies, oncolytic viruses, drug delivery platforms, and novel targeted agents. For muscle-invasive disease, perioperative systemic treatment has also changed dramatically. Neoadjuvant chemotherapy remains an important standard, but immunotherapy has become an integral part of treatment in selected patients, and combination perioperative approaches are continuing to improve outcomes. Perhaps the biggest shift is that treatment decisions are becoming increasingly personalised. Rather than asking ‘what is the standard treatment?’, we now ask, ‘which treatment is best for this particular patient?’.
What are the biggest challenges still facing patients with bladder cancer today?
Despite the progress, several major challenges remain. First, early diagnosis is still difficult because haematuria is often ignored or investigated late. Second, bladder cancer requires lifelong surveillance, which is invasive, costly, and places a considerable burden on patients. Third, we still lack reliable biomarkers that can accurately predict which patients will respond to specific treatments. Finally, access to innovative therapies varies substantially between countries, meaning that patients do not always benefit equally from recent scientific advances. Addressing these challenges requires not only better treatments but also better diagnostics, improved healthcare organisation, and broader access to innovation.
Your research has explored liquid biopsy and microRNA in bladder cancer. How could these technologies transform diagnosis and disease monitoring?
Liquid biopsy has enormous potential to transform the way we diagnose and monitor bladder cancer. Unlike many other cancers, bladder cancer offers a unique advantage because urine is in direct contact with the tumour, making it an ideal source of clinically meaningful biomarkers. This is precisely the vision behind Danae Urogenomics, Madrid, Spain, the biotech company I co-founded. Our mission is to develop non-invasive urinary biomarkers that help clinicians make better decisions throughout the patient’s journey, from diagnosis and surveillance to predicting response to treatment. I believe the future is not about replacing cystoscopy altogether, but about making surveillance smarter. If we can accurately identify which patients truly need invasive procedures and which do not, we can reduce patient burden, optimise healthcare resources, and improve quality of care. Ultimately, I see molecular biomarkers becoming an integral part of routine clinical practice, complementing pathology, imaging, and clinical assessment to deliver genuinely personalised medicine.
Which developments in bladder cancer research are you most excited about at the moment?
There are several exciting developments. One is the emergence of bladder-preserving strategies that may allow selected patients to avoid radical cystectomy without compromising oncological outcomes. Another is the rapid development of novel intravesical therapies for Bacillus Calmette-Guérin-unresponsive disease, offering realistic alternatives for patients who previously had very limited options. I am also particularly interested in biomarker-driven treatment selection. The future is not simply about developing more drugs; it is about identifying the right treatment for the right patient at the right time. Finally, I believe AI will increasingly complement molecular diagnostics and improve clinical decision-making.
How do you see AI contributing to the diagnosis, treatment, and management of bladder cancer in the coming years?
AI has tremendous potential, but it should be viewed as a tool rather than a replacement for clinicians. AI can help analyse imaging, pathology, and molecular data much faster than humans alone, assisting with diagnosis, prognostic assessment, and treatment selection. It may also improve clinical workflows, automate routine documentation, and facilitate clinical trial recruitment. However, medicine remains fundamentally human. Clinical judgement, communication with patients, and shared decision-making cannot be replaced by algorithms. The future will likely involve clinicians working alongside AI rather than competing with it.
Which findings from this year’s American Society of Clinical Oncology (ASCO) Annual Meeting were particularly significant for bladder cancer?
One of the most encouraging aspects of this year’s ASCO Meeting was the continued maturation of data supporting new perioperative treatment strategies and novel therapies across different disease settings. We also saw growing evidence supporting innovative bladder-preserving approaches and encouraging results from emerging intravesical therapies for non-muscle-invasive disease. Another important theme was the increasing integration of biomarkers into clinical research, reflecting the field’s movement towards precision medicine. Overall, the Meeting reinforced the idea that bladder cancer is one of the fastest-evolving areas within uro-oncology.
What are you most looking forward to seeing at the upcoming European Society for Medical Oncology (ESMO) Congress?
The ESMO Congress is always an important opportunity to see mature data from ongoing Phase III studies and to understand how recent advances will translate into routine clinical practice. I will be particularly interested in long-term outcomes from perioperative immunotherapy studies, updates on novel intravesical therapies, and new biomarker analyses that may help personalise treatment. Equally valuable are the discussions between experts, as they often provide insights into how evidence is being interpreted and implemented in real-world practice.
Looking ahead, what would you most like to see change in the way bladder cancer is diagnosed and treated?
My hope is that we move towards truly personalised management. I would like to see reliable molecular biomarkers guiding diagnosis, surveillance, and treatment selection, reducing unnecessary procedures while improving patient outcomes. I also hope that effective bladder-preserving strategies become available for a greater proportion of patients, allowing us to maintain quality of life without compromising cancer control. Most importantly, I would like every patient to have access to innovative treatments and clinical trials regardless of where they live. Ultimately, our goal should not simply be to treat bladder cancer more effectively, but to treat each individual patient more intelligently.
