|
|
|
|
|
|
|
PEER-TO-PEER CLINICAL CONVERSATIONS
|
|
|
|
|
|
|
Non-Surgical Management of Non-Muscle Invasive Bladder Cancer: Surveillance, Chemoablation, and Office-Based Approaches
|
Katie Murray, DO, MS, FACS
Katie Murray discusses non-surgical management options for non-muscle invasive bladder cancer, covering patient populations in whom TURBT may be deferred. She identifies recurrent low-grade disease with a documented history as the clearest candidate for surveillance, office fulguration, or chemoablation with UGN-102, particularly in elderly or high-comorbidity patients.
|
|
|
|
|
|
|
|
|
|
|
|
Randomized Trial of Blue Light Versus White Light TURBT with Urinary Tumor DNA Testing
|
| Armine Smith and Meghan McNamara describe a randomized study combining blue light TURBT with UroAmp urinary tumor DNA testing. UroAmp assesses minimal residual disease from urine based on 60 genes, allowing biological quantification of disease burden alongside the visual assessment of resection.
|
|
|
|
|
|
|
|
|
|
|
|
Moving Beyond Repeat TURBT in Recurrent NMIBC
|
John Sfakianos, MD
John Sfakianos discusses non-surgical management of bladder cancer, focusing on chemoablation and bladder preservation strategies for appropriately selected patients with recurrent NMIBC. He reviews emerging durability data and how alternatives to repeat TURBT may fit into clinical decision-making.
|
|
|
|
|
|
|
|
|
|
|
| Bacillus Calmette-Guérin-exposed Non-muscle-invasive Bladder Cancer: Survival Benchmarks, Bladder-sparing Strategies, and Implications for Trial Design - Beyond the Abstract
|
| Renzo G. Di Natale, MD, MSc, and Roger Li, MD
|
| Renzo Di Natale, and Roger Li argue that BCG-exposed NMIBC is a clinically useful but biologically blunt category: patients in the BCG-exposed and BCG-unresponsive groups had similarly poor outcomes, suggesting current time-based definitions do not fully capture tumor behavior. Drs. Di Natale and Li also highlight that BCG remains the benchmark salvage therapy, but future trial design should shift toward biology-driven tools like urinary tumor DNA and molecular subtyping to better predict response and guide treatment.
|
|
|
|
|
|
| Sequencing Therapies in BCG-Unresponsive, High-Risk NMIBC
|
| Vignesh Packiam, MD, Amanda Myers, MD, MS, and Bogdana Schmidt, MD, MPH
|
| This debate centered on whether gemcitabine/docetaxel should be the default first-line bladder-sparing option for BCG-unresponsive high-risk NMIBC. Amanda Myers argued yes, citing durable responses, low toxicity, low cost, and wide availability, while Bogdana Schmidt argued for individualized sequencing rather than a universal standard, emphasizing evidence quality, treatment burden, and preserving future options.
|
|
|
|
|
|
|
|
|
|
|
| Quality Care Measures Among Patients with High-Risk Non-Muscle Invasive Bladder Cancer with Papillary Carcinoma or CIS Receiving Front-Line BCG or Other Intravesical Therapies
|
| Mukul Singhal, PhD
|
| In a large SEER-Medicare analysis of 17,495 Medicare patients with high-risk NMIBC starting frontline bladder-sparing therapy, major quality-of-care gaps were common: 44% of BCG patients did not start within 90 days, 46% received inadequate induction/maintenance, and nearly half missed recommended surveillance cystoscopy intervals. Similar shortcomings were seen with other intravesical therapies, along with low repeat TURBT rates and substantial readmissions, underscoring opportunities to improve real-world care delivery and monitoring.
|
|
|
|
|
|
| Blue Light Cystoscopy Enables Earlier CIS Recognition and Can Guide Risk-Appropriate Management of High-Risk NMIBC: Real-World Outcomes from a U.S. Claims Cohort
|
| Mark Tyson II, MD, MPH
|
| Mark Tyson discusses how blue light cystoscopy was associated with earlier recognition of CIS and more aggressive downstream management in this real-world claims cohort. Compared with white light cystoscopy, it detected CIS more often within 90 days and was linked to higher early BCG use and cystectomy rates, suggesting it may help triage patients toward risk-appropriate treatment.
|
|
|
|
|
|
| A Histopathology-Driven AI Biomarker for Predicting Progression, High-Grade Recurrence, and Early BCG Failure in NMIBC
|
| Kyle Richards, MD, FACS
|
| Kyle Richards discusses how an AI biomarker built from H&E whole-slide pathology images was able to predict progression, high-grade recurrence, and early BCG failure in NMIBC, and it performed better when combined with tumor focality. In external validation, the multimodal model separated patients into clear risk groups, with high-risk patients having significantly worse progression-free and high-grade disease-free survival, supporting AI pathology as a useful add-on to standard clinicopathologic risk stratification.
|
|
|
|
|
|
|
|
|
|
|
