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Highlights from the 2022 American Urological Association Annual Meeting
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| The International Bladder Cancer Group (IBCG) AUA Bladder Cancer Forum
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| Should Variant Histology Change the Management of Bladder Cancer? Pro
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| Mario I. Fernandez, MD
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| The 2022 Annual Meeting of the American Urological Association was host to a case-based debate about the significance of variant histology on changes in the management of bladder cancer patients. This session was moderated by Dr. Peter Black and Dr. Mario Fernandez was tasked with providing support to the argument that presence of variant histology should change the management of bladder cancer patients.
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| Should Variant Histology Change the Management of Bladder Cancer? Con |
| Michael O’Donnell, MD |
| Following Mario Fernandez, Michael O’Donnell was tasked with providing an argument to the debate presence of variant histology should change the management of bladder cancer patients. Dr. O’Donnell began his presentation by highlighting the difficulties in assessing treatment response in micropapillary non-muscle invasive bladder cancer (NMIBC). |
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| State-of-the-Art Lecture: IBCG Master Class on TURBT |
| Arnulf Stenzl, MD |
| The 2022 Annual Meeting of the American Urological Association was host to a State-of-the-Art Lecture: IBCG Master Class on transurethral resection of bladder tumors (TURBT) presented by Dr. Arnulf Stenzl. Dr. Stenzl began his presentation by noting that bladder cancer has an incidence of 180,000 cases per year in Europe. TURBT remains the gold standard for the initial diagnosis and staging of bladder cancer. The value of a well-performed TURBT remains critical with the percentage of residual cancer at re-staging TURBT being heavily influenced by the performing surgeon’s experience (consultant versus trainee). |
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| State-of-the-Art Lecture Discussant
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| Sarah Psutka, MD, MSc |
| The 2022 Annual Meeting of the American Urological Association was host to a brief State-of-the-Art Lecture discussion that followed the presentation by Dr. Arnulf Stenzl regarding the role of transurethral resection of bladder tumor (TURBT). Dr. Psutka concisely outlined the key elements in her practice for an excellent TURBT. |
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| Do I need to do Repeat TUR for all High Grade NMIBC Patients? Pro
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| Trinity Bivalacqua, MD, Ph.D.
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| The 2022 Annual Meeting of the American Urological Association was host to a case-based debate regarding the role of repeat transurethral resection of bladder tumors (TURBT) for all high grade non-muscle invasive bladder cancers (NMIBC). This session was expertly moderated by Dr. Neal Shore, and Dr. Trinity Bivalacqua was tasked with arguing in favor of repeat TURBT in this setting. |
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| Do I Need to do Repeat TUR for All High Grade NMIBC Patients? Con
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| J.A. (Fred) Witjes, MD
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| Regarding the role of repeat transurethral resection of bladder tumors (TURBT) for all high grade non-muscle invasive bladder cancers (NMIBC). The AUA 2022 Annual Meeting featured a session moderated by Dr. Neal Shore, with Dr. Witjes was tasked with arguing against repeat TURBT in this setting. Dr. Witjes began his discussion by noting that although he will argue against TURBT, current EAU guidelines do recommend performing a repeat TURBT in high-risk HG Ta and T1 tumors.
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| State-of-the-Art Lecture: BCG Unresponsive Disease
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| Seth P. Lerner, MD, FACS
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| The 2022 Annual Meeting of the American Urological Association was host to a State-of-the-Art lecture by Dr. Seth Lerner regarding the current state of BCG unresponsive disease. Dr. Lerner began his talk by introducing the revised definition of “BCG Unresponsive” high risk non-muscle invasive bladder cancer (NMIBC).
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| Timing of Radical Cystectomy in BCG Unresponsive Disease |
| Patrick Hensley, MD |
| Patrick Hensley was tasked with discussing the timing of radical cystectomy in BCG-unresponsive patients. Dr. Hensley began his presentation by highlighting the current limitations in clinical staging accuracy. A series of 1,136 patients HGT1 patients treated with radical cystectomy demonstrated that almost half had T2 disease or worse, and there was lymph node involvement in 16.2% of cases. There are currently no prospective trials randomizing patients to novel bladder-sparing therapies versus standard of care radical cystectomy for patients with BCG-unresponsive non-muscle invasive bladder cancer (NMIBC). |
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| State-of-the-Art Lecture: Systemic Therapy for Muscle Invasive Bladder Cancer (Non Metastatic)
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| Matthew Galsky, MD
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| In this State-of-the-Art lecture, Matthew Galsky discussed systemic therapy options for non-metastatic, muscle-invasive bladder cancer (MIBC). Dr. Galsky began his presentation by acknowledging that surgery alone is potentially curative for MIBC, but the risk of metastatic recurrence remains high.
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| State-of-the-Art Lecture Discussion: Systemic Therapy for Muscle Invasive Bladder Cancer (Non Metastatic) |
| Stephen B. Williams, MD, MS |
| Stephen B. Williams provided a discussant presentation regarding systemic therapy for muscle-invasive bladder cancer. This discussion followed the presentation by Dr. Matthew Galsky. As Dr. Galsky had done previously, Dr. Williams began his discussion by highlighting the currently available phase 2 trials exploring neoadjuvant immunotherapy for muscle-invasive bladder cancer. These trials have demonstrated pT0N0 rates of 7-46%, which are similar to those seen with historical neoadjuvant chemotherapy regimens. |
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| In Patient with Pure T2 UC, PD-L1-high, GFR 60 do I need Neoadjuvant Therapy? Pro
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| Shilpa Gupta, MD
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| The 2022 Annual Meeting of the American Urological Association was host to a case-based debate regarding the role of neoadjuvant therapy in a patient with pure T2 urothelial cancer, PD-L1-high, and eGFR of 60 ml/min. This session was moderated by Dr. Siamak Daneshmand, and Dr. Shilpa Gupta was tasked with providing arguments in favor of administering neoadjuvant therapy in this setting.
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| In Patient with Pure T2 UC, PD-L1-high, GFR 60 do I need Neoadjuvant Therapy? Con |
| Arlene O. Siefker-Radtke, MD |
| Following the presentation by Shilpa Gupta, Arlene Siefker-Radtike was tasked with providing arguments against administering neoadjuvant therapy in this setting. Dr. Arlene O. Siefker-Radtke began her presentation by emphasizing that the goal of treatment in this setting is to maximize efficacy, while minimizing the toxicity profile. Although SWOG-8710 trial by Grossman et al. has changed clinical practice by demonstrating an improved 5-year OS from 43% to 57% with 3 cycles of MVAC, the difference, although clinically significant, was not statistically significant (p=0.06). |
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| Do we need to Perform Radical Cystectomy for Patient who is cT0 after Neoadjuvant Chemotherapy? Pro |
| Gary Steinberg, MD |
| Gary Steinberg was tasked with providing arguments in favor of radical cystectomy for a patient who is cT0 after Neoadjuvant Chemotherapy. Dr. Smith began the debate with a case presentation of a 63-year-old relatively healthy male who was diagnosed with HG T2 bladder cancer. After being seen in a multidisciplinary clinic, decision was made to proceed with NAC followed by radical cystectomy. This patient received 4 cycles of ddMVAC with repeat imaging demonstrating no evidence of a bladder mass. The patient now asks if cystectomy is needed? |
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| Do we need to Perform Radical Cystectomy for Patient who is cT0 after Neoadjuvant Chemotherapy? Con |
| John A. Taylor, III, MD, MS |
| The 2022 Annual Meeting of the American Urological Association was host to a case-based debate regarding the role of radical cystectomy in a patient who achieves a cT0 status after neoadjuvant chemotherapy. This session was moderated by Dr. Angela Smith, and Dr. John Taylor III was tasked with providing arguments against radical cystectomy in this setting. |
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| Is there a Role of Radical Cystectomy in cN1-2 Disease? Pro |
| Kamal S Pokar, MD and Brant Inman, MD, MS |
| The 2022 Annual Meeting of the American Urological Association was host to a case-based debate regarding the role of radical cystectomy in cN1-2 disease. This session was moderated by Dr. Kamal Pohar, and Dr. Brant Inman was tasked with providing arguments in favor of radical cystectomy in this setting. Dr. Pohar began the debate by presenting a case of a patient that completed 5 of 6 planned cycles of dd-MVAC (limited by toxicities) for cT2N1 disease. Post-chemotherapy CT imaging demonstrated an almost complete response in the pelvic node (now 2x3 mm). |
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| Is there a Role of Radical Cystectomy in cN1-2 Disease? Con |
| Yair Lotan, MD |
| Yair Lotan was tasked with providing arguments against radical cystectomy in this setting. Dr. Lotan began his presentation with the following key questions: Does negative imaging prior to cystectomy correctly identify patients who are pathologically node negative? After induction chemotherapy, is there a different outcome if a patient is pN0 or pN+? Does consolidative treatment improve survival? |
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