Nanomedicine in immunotherapy of urinary system tumors: advances, synergistic strategies, and translational challenges

Urological malignancies impose a substantial global health burden, underscoring the urgent need for more effective therapeutic strategies. Although immunotherapy has transformed cancer management, its benefit in urological tumors remains inconsistent, often limited by tumor-intrinsic resistance and an immunosuppressive tumor microenvironment. In this setting, nanomedicine has emerged as a promising platform that extends beyond conventional drug delivery to actively modulate antitumor immune responses through engineered nano-bio interactions. This review presents a mechanistically organized overview of nanomedicine-enabled immunotherapeutic strategies for urological cancers, focusing on prostate cancer, renal cell carcinoma, and bladder cancer. We examine how advanced nanoplatforms regulate antitumor immunity through targeted delivery, externally activatable photodynamic immunotherapy, tumor immune microenvironment reprogramming, immunotherapy sensitization and combination strategies, and neoantigen-based vaccination. We also discuss key translational barriers-including delivery heterogeneity, biosafety, manufacturing scalability, and patient stratification-and outline design considerations for developing clinically translatable nano-based immunotherapeutic. Overall, this review highlights the potential of nanomedicine to overcome current limitations in cancer immunotherapy and to support the development of more effective, personalized treatments for urological malignancies.