Integration of Radiotherapy and Immunotherapy in Urological Cancers: Hype or Hope?

Background: The integration of radiotherapy (RT) and immunotherapy (IO) is transforming oncologic paradigms by combining local tumor control with systemic immune activation. In urological cancers—prostate, bladder, and renal cell carcinoma—this strategy is supported by growing biological rationale and promising early clinical results. Methods: This narrative review synthesizes preclinical and clinical evidence on RT–IO combinations in urological malignancies. A comprehensive literature search was performed in PubMed, Embase, and ClinicalTrials.gov, focusing on mechanistic insights, clinical trials, and translational challenges related to RT–IO synergy. Results: Early-phase studies in bladder and renal cell carcinoma demonstrate feasibility, immunogenic enhancement, and manageable toxicity when RT is combined with checkpoint inhibitors. Prostate cancer remains less immunoresponsive but may benefit from RT-induced immune priming, particularly in biomarker-enriched subgroups. Innovations in precision RT, biomarkers, artificial intelligence, and novel immunotherapeutics are shaping future applications. Conclusions: RT–IO combinations represent a promising yet complex frontier in urological oncology. Future success will rely on precision-guided patient selection, optimized trial design, and equitable global implementation to ensure durable clinical benefit.