Combination Therapy in Urological Malignancy

Any discussion of the present success in management of urological cancers evokes a mixed response. Oncologists and urologists can enjoy the success with chemotherapy for testicular cancers but cannot forget the dismal results with any form of treatment, other than surgery, for renal carcinoma. But these are the less frequent urolegi­ cal tumours: what are the attitudes to the more common prostate and bladder cancers. Intensive study, many clinical trials and much debate lead us to the conclusion that we understand them better, we can tailor the treatment more appropriately to the individual patient but there remains some uncertainty as to the overall success that we have achieved. There have been no striking changes in the 5-year survival data. Clinicians tend to see their success in terms of their special interest. Radiotherapists point to their success in stage-reduction but what are we to do with the many patients whose tumour is unaltered by radiotherapy. Urological surgeons, and especially those who are still influenced by the shadow of Halsted, point to their success in excising the cancer but apart from that highly selected group, what are we to do for the very large number of patients for whom surgery is inappro­ priate. Bystanders can only watch and listen to the arguments for and against these views.