The American Urological Association (AUA) and the Society of Urologic Oncology (SUO) have released a new clinical practice guideline for non–muscle-invasive bladder cancer (NMIBC). The new document outlines guidance on a variety of topics, including diagnosis and treatment, as well as a risk-stratified clinical framework for postsurgical management of the disease. The guideline will be presented in May at the 2016 AUA annual meeting in San Diego, California.
NMIBC accounted for approximately 75% of the 74,000 estimated new bladder cancer cases diagnosed in the United States in 2015. Bladder cancer is the fourth most-common solid malignancy in men and caused an estimated 16,000 deaths in the U.S. last year.
While the survival rate for most patients with NMIBC (cases where the tumors are still localized to the urothelium) is favorable, certain clinical and pathological factors can affect overall prognoses and long-term outcomes. The new AUA/SUO document outlines steps that practitioners can take before and after surgical intervention (transurethral resection of bladder tumor [TURBT]) to better predict and manage disease progression.
Specifically, the guideline makes recommendations in the following areas:
- Diagnosis (including the role of cystoscopic examination, biopsy, and cytology; upper tract imaging; and visual resection)
- Risk stratification and pathological predictors (including variant histologies, cytology, and urinary biomarkers)
- Surgical intervention (including timing, techniques, goals, and indications for TURBT/repeat resection, as well as the role of enhanced cystoscopy and cystectomy)
- Intravesical therapy (Bacillus Calmette–Guerin [BCG]/maintenance and combination therapies)
- BCG relapse and salvage regimens
- Risk-adjusted surveillance and follow-up strategies
“We’ve come a long way in understanding bladder cancer and how to treat and manage this disease, and this guideline takes our knowledge one step further by refining our approach and allowing us to provide more individualized treatment to our patients,” said Dr. Sam S. Chang, who led the panel that developed the guideline. “Determining a patient's risk of recurrence and/or progression is an essential part of managing bladder cancer, and this panel has attempted to integrate disease characteristics and treatment response.”