Emerging Biomarkers in Urological Cancers: Angiogenesis and Damage-Associated Molecular Pattern Signaling

The interaction between tumor cells and stroma in urological malignancies is governed by secreted and damage-associated factors that promote angiogenesis, immune modulation, and metastasis. This review synthesizes current evidence on six biomarkers—GDF15, VEGF, TGF-β1, HSP90, HMGB1, and S100A9—detailing their biological functions and clinical implications. We discuss GDF15’s roles in metabolic stress and immune regulation, VEGF’s central role in neovascularization, and TGF-β1’s dualistic tumor-suppressive and promotive effects. We then examine damage-associated molecular patterns, highlighting HSP90’s extracellular immunomodulation, HMGB1’s signaling via pattern-recognition receptors, and S100A9’s pro-inflammatory activity through RAGE and Toll-like receptors. Comparative analyses across renal cell carcinoma and bladder cancer cohorts elucidate each marker’s diagnostic accuracy, prognostic value, and predictive capacity for targeted therapies. Notably, GDF15 and HSP90 correlate with ferroptosis susceptibility in RCC and urinary VEGF with HMGB1 increases the chances of non-invasive bladder cancer detection. We suggest that multiplexed biomarker panels could enhance early detection, risk stratification, and personalized treatment in urological oncology. We advocate for prospective studies to validate thresholds, clarify interactions, and improve clinical integration.