Advancing Precision Oncology: The Role of Molecular and Genetic Markers in Liquid Biopsy for Urogenital Cancers

Liquid biopsy has emerged as one of the most promising approaches in precision oncology by enabling minimally invasive, real-time molecular characterization of tumors. Despite growing evidence, its clinical utility in urogenital cancers remains insufficiently defined. Differences in tumor biology, assay sensitivity and availability of tumor-derived material limit the assessment of its diagnostic, prognostic and predictive value across individual malignancies. This review summarizes the biological basis of liquid biopsy and evaluates its current and emerging clinical applications in prostate, bladder, renal cell, testicular, and penile cancers. Particular emphasis is placed on its potential for molecular tumor characterization, risk stratification, treatment selection, monitoring of therapeutic response and resistance, and detection of minimal residual disease. The current evidence indicates that liquid biopsy provides complementary information to tissue biopsy, particularly by enabling repeated sampling and longitudinal monitoring of tumor evolution. Its clinical value appears most relevant when tissue acquisition is challenging or dynamic molecular assessment is required. However, important limitations include low levels of tumor-derived material in selected malignancies, methodological heterogeneity, and insufficient prospective validation. Liquid biopsy should currently be considered a complementary rather than a replacement approach to tissue biopsy. Further technological advances, methodological standardization, and prospective clinical validation may facilitate its broader integration into clinical practice and support more precise diagnosis, treatment monitoring, and personalized management of urogenital cancers.