[Treatment options in rare urological tumors: potential of molecular tumor boards].

Rare urological tumors such as neuroendocrine prostate cancer, non-clear cell renal cell carcinoma, penile carcinoma, and non-urothelial bladder tumors are defined by low incidence, biological heterogeneity, and limited evidence-based treatment options. Molecular tumor boards (MTBs) have emerged as a key strategy to facilitate personalized therapy by integrating histopathological, genomic, and clinical data. This narrative review summarizes the current state of molecular approaches in rare urological malignancies, focusing on pathogenesis, clinical characteristics, and systemic treatment strategies. Special emphasis is placed on the potential of MTBs to identify relevant targets in aggressive or refractory cases and to initiate experimental treatments, such as antibody-drug conjugates (ADCs), immune checkpoint inhibitors (ICI), and molecularly targeted therapies. As tumor-agnostic approvals increase, comprehensive molecular profiling becomes essential, even in rare entities. MTBs thus represent an important tool for improving care in this complex patient population.