Genitourinary cancers are common cancers. They include prostate, bladder, renal and testis cancers. Surgical management has evolved in the past 20 years, particularly with the advent of robotic surgeries. Other surgical technologies include cryoablation, high intensity focused ultrasound. Improvements in diagnostics such as multiparametric MRI scanning help guide surgery. Challenges in implementation include the cost of technologies, training, device company support, infrastructure amongst others. A proposal would be to have regional centres where patients can be directed to access the expertise.

While data from clinical trials and recommendations from treatment guidelines define optimal care for patients with cancer, it is well known that there are often gaps between evidence and practice. There is also uncertainty regarding the extent to which patients in the general population are able to access care, the quality of care that is delivered, and whether outcomes in the "real world" are as expected based on results of clinical trials. These challenges are pervasive in all health systems but may be particularly acute in low resource settings. This presentation will review how population-level data and health services research can offer critical insights to drive health system performance and improve outcomes for patients globally. Specific examples related to urologic cancer (including bladder and testicular cancer) will be used to illustrate these concepts. Examples of studies from LMICs will also be used to illustrate potential collaborative projects that may be launched through the AORTIC network.

Cancer is an emerging public health problem in Africa. According to the World Health Organisation (WHO), numbers will double by 2030, due to the aging and the growth of the population. Prostate cancer is the most common cancer among men in most African countries. For a large proportion of prostate cancer patients, external-beam radiotherapy (EBRT) will be the treatment of choice in Africa due to limitations of surgical expertise in many countries. The disparity between the α/β ratio for late complications and the low α/β ratio for prostate cancer widens the therapeutic window when treating prostate cancer with hypofractionation (larger fraction doses in shorter period of time). Hypofractionated schedules for prostate cancer have been used for many years, but only more recently a variety of schedules have been tested in several clinical randomized trials. The most commonly used schedule for any stage localized prostate cancer is 20 fractions of 3 Gy, 5 times/week. Due to the reduced number of treatment days, hypofractionation offers economic and logistic advantages, reducing the burden of the very limited radiotherapy resources in most African countries. It also increases patient convenience. On the other hand, to limit side effects hypofractionation requires geometric accuracy, even more than conventional radiotherapy. A misleading assumption is that high level radiotherapy is not feasible in low-income countries. The gold-standard option for hypofractionation includes daily image-guided radiotherapy with 3-4 implanted gold fiducials. CT-based treatment planning with MRI fusion allows for accurate volume delineation. Volumetric Modulated Arc therapy (VMAT) or inversely planned intensity modulated radiotherapy (IMRT) are the ideal for treatment delivery. The most vital component is safe delivery which necessitates accurate quality assurance measures and onboard imaging.

Psychosocial and sexual counselling are under appreciated, under recognised, under discussed and a commonly unaddressed need in the cancer care models in Africa.
The low 5‑year survival rates in Africa are mainly associated with lack of early detection programs, adequate diagnosis, and treatment facilities, resulting in a high proportion of persons presenting with late‑stage disease. “Psychosocial counselling” covers a group of nonpharmacologic therapeutic interventions that can address the psychological, sexual, social, personal, educational, fertility or relational needs of a patient. Common sexual issues affecting people with cancer issues to consider include sexual response, body image, intimacy and relationships, altered sexual function and satisfaction, vasomotor symptoms, and genital symptoms (women). In men, it also includes erectile dysfunction and the absence of ejaculation. Numerous studies have reported the issue of limited psychosocial support being available for cancer survivors in Africa
The overarching recommendation is that there be a discussion with the patient, initiated by a member of the health care team, about psychosocial and sexual health and dysfunction resulting from the cancer or its treatment. The integration of cancer programs into existing health care services in primary health‑care facilities that are accessible to most women is one of the most reliable, cost‑effective interventions that can be utilized in Africa The use of social media tools to bring information into the most rural areas with minimal or no cost will be explored. Special interest groups in AORTIC which can address these issues to bring care to all will assist in delivering HOLISTIC care to cancer patients.