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AUA – IBCG Bladder Cancer Forum: Common Problems and Controversies in Bladder Cancer
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Ashish Kamat, MD, MBBS, and Kelly Bree, MD
The AUA-IBCG Bladder Cancer Forum at AUA 2025, co-chaired by Drs. Ashish Kamat and Kelly Bree, brings global experts together to discuss emerging evidence and key debates in bladder cancer care for clinical decision-makers. |
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Highlights from the 2025 AUA-IBCG Bladder Cancer Forum |
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| Is There a Role for AI in Diagnosis and Risk Stratification for Bladder Cancer? |
| Hikmat Al-Ahmadie, MD, and Alexandre Zlotta, MD |
| Hikmat Al-Ahmadie and Alexandre Zlotta debated the potential role of artificial intelligence (AI) in diagnosing and risk stratifying bladder cancer. Dr. Zlotta emphasized AI's ability to enhance prognostic tools for non-muscle invasive bladder cancer, highlighting the PROGRxN-BCa model's superior accuracy in predicting progression risk compared to current methods. Meanwhile, Dr. Al-Ahmadie noted AI's potential in improving histopathological grading, though he stressed that traditional histology remains effective and adaptable, with AI enhancing its utility through image analysis. |
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| Patient with High Risk NMIBC: Balancing BCG with New and Emerging Treatments in the Era of Personalized Medicine
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| Joshua Meeks, MD, PhD, and Benjamin Pradere, MD, MSc
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| Joshua Meeks and Benjamin Pradere debated the balance between BCG and emerging treatments for high-risk non-muscle invasive bladder cancer (NMIBC). Dr. Meeks highlighted BCG's established efficacy and tolerability, despite challenges like recurrence and treatment adherence, while Dr. Pradere acknowledged BCG's limitations and discussed alternatives like gemcitabine + docetaxel and the CREST trial’s promising results with sasanlimab combined with BCG. The debate underscored the need for personalized medicine and the ongoing search for effective alternatives to BCG in high-risk NMIBC treatment.
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| Optimal Sequencing: My Patient Has BCG Unresponsive NMIBC and Declines Radical Cystectomy |
| Wes Kassouf, McGill, MD, and Michael O’Donnell, MD |
| Michael O’Donnell and Wes Kassouf debated second-line options for patients with BCG-unresponsive NMIBC who decline radical cystectomy. Dr. O’Donnell advocated for intravesical gemcitabine + docetaxel, citing strong long-term data supporting its efficacy and tolerability, while Dr. Kassouf promoted the novel N-803 + BCG combination for its immunologic synergy and FDA-approved, prospective trial-based efficacy. Post-debate polling showed increased support for gemcitabine + docetaxel (73%), reflecting a shift away from radical cystectomy and newer agents. |
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| What Constitutes an Optimal TURBT in 2025? |
| Vignesh Packiam, MD, and Mark Tyson II, MD, MPH |
| Drs. Vignesh Packiam and Mark Tyson debated what defines an optimal TURBT, emphasizing that while technology like blue light cystoscopy and bipolar resection enhance outcomes, surgical technique and judgment remain paramount. Both agreed that the best results come from skilled surgeons leveraging modern tools to achieve complete resections, accurate pathology, and improved recurrence-free survival in non-muscle invasive bladder cancer. |
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| Active Surveillance for Low-Grade Intermediate Risk Bladder |
| Laura Bukavina, MD, MPH, and Morgan Roupret, MD, PhD |
| Drs. Morgan Roupret and Laura Bukavina debated active surveillance for low-grade intermediate risk bladder cancer, with Dr. Roupret advocating for it based on low progression risk, quality of life benefits, and cost-effectiveness in properly selected patients. Dr. Bukavina countered that this patient’s tumor burden and recurrence pattern, along with limitations in risk stratification accuracy, make him a poor candidate for surveillance, warning that delays in treatment can lead to upstaging. Post-debate, support for active surveillance dropped from 11% to 3%, while preference for office fulguration increased. |
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| Is TMT Really a Valid Option for All My Patients with MIBC |
| Kent Mouw, MD, PhD, and Bogdana Schmidt, MD, PhD |
| Kent Mouw and Bogdana Schmidt debated the role of trimodality therapy (TMT) for muscle invasive bladder cancer. Dr. Mouw argued that TMT offers comparable survival and better quality of life than radical cystectomy in well-selected patients, while Dr. Schmidt emphasized that TMT is only suitable for a minority with small, unifocal tumors and complete TURBT, reaffirming radical cystectomy as the gold standard. Audience polling post-debate showed increased concern over poor baseline bladder function as the main barrier to recommending TMT. |
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| Should I Use ctDNA to Guide Treatment Decisions Regarding Adjuvant Chemotherapy or IO Therapy after Radical Cystectomy?
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| Roger Li, MD, and Jonathan Rosenberg, MD
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| Roger Li and Jonathan Rosenberg debated whether ctDNA should guide adjuvant chemotherapy or immunotherapy decisions after radical cystectomy in bladder cancer. Dr. Li supported its use, citing trials like CheckMate-274 and IMvigor010 that show ctDNA's prognostic value, while Dr. Rosenberg cautioned that more prospective data is needed, arguing that ctDNA's role as a predictive biomarker is still unclear and that other therapies may benefit ctDNA-negative patients.
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| Bladder Preservation in Patients with Clinical Complete Response to Neoadjuvant Chemotherapy – Ready for Prime Time? |
| Sia Daneshmand, MD, and Matthew Galsky, MD |
| Matthew Galsky and Sia Daneshmand debated whether bladder preservation is appropriate for patients with a clinical complete response (cCR) after neoadjuvant chemotherapy. Dr. Galsky emphasized emerging evidence and the need for prospective studies to support bladder-sparing approaches, while Dr. Daneshmand highlighted limitations in current staging accuracy and recurrence risks, arguing that cystectomy remains standard. Audience polling showed most clinicians still favor surgical consolidation, reflecting ongoing caution despite promising trial data. |
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