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PEER-TO-PEER CLINICAL CONVERSATIONS |
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Management Strategies for Low-Grade Intermediate-Risk Bladder Cancer
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Sarah Psutka, MD, MS
Zachary Klaassen hosts Sarah Psutka to discuss low-grade, intermediate-risk non-muscle invasive bladder cancer. Dr. Psutka characterizes this as a heterogeneous disease category sitting between low-risk (small, single low-grade Ta) and high-risk disease, primarily consisting of low-grade Ta tumors that can be multifocal or recurrent.
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A Multi-Center Study Examines Maintenance Schedules for Intermediate-Risk NMIBC
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Roberto Contieri, MD
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| Roberto Contieri presents a retrospective multicenter study of 292 intermediate-risk Ta non-muscle-invasive bladder cancer patients from 13 Italian centers.
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Risk Stratification for Active Surveillance in Low and Intermediate-Risk Bladder Cancer
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Marco Moschini, MD, PhD
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| Ashish Kamat speaks with Marco Moschini about expanding active surveillance criteria for recurrent low-grade bladder cancer. Dr. Moschini presents his single-center retrospective study from San Raffaele Hospital analyzing outcomes among intermediate-risk non-muscle invasive bladder cancer patients based on IBCG risk stratification.
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| Clinical Validation of the International Bladder Cancer Group's Intermediate-risk Non-muscle-invasive Bladder cancer Stratification Model
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| Jayant Siva, MD
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| Jayant Sive presents this large validation study which showed that the IBCG intermediate-risk NMIBC model cleanly separates patients into three prognostic groups with very different 3-year recurrence and progression rates. The practical message is that the model can help identify which “intermediate-risk” patients are truly low, intermediate, or high risk, which should improve decisions about intravesical therapy and surveillance intensity.
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| Intermediate Risk NMIBC: Risk Stratification
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| Wei Shen Tan, MD, PhD, FRCS
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| Wei Shen Tan presents intermediate-risk NMIBC as a highly heterogeneous disease that cannot be managed as a single category. He highlights how the IBCG model helps separate patients into clinically meaningful subgroups, with recurrence risk rising sharply across strata while progression remains comparatively low, supporting more personalized decisions such as active surveillance, office fulguration, or adjuvant intravesical therapy.
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| Active Surveillance for Low-Grade Intermediate Risk Bladder
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| Laura Bukavina, MD, MPH, and Morgan Roupret, MD, PhD
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| Wei Shen Tan moderated a debate on whether active surveillance is appropriate for low-grade intermediate-risk NMIBC, using a 75-year-old man with recurrent low-grade Ta disease as the case. Morgan Roupret argued surveillance can reduce overtreatment and preserve quality of life in selected patients, while Laura Bukavina argued this patient’s repeated recurrences and multiple risk factors make surveillance too risky and potentially delay needed treatment.
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| Patient Time Toxicity from Management Options for NMIBC
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| Veerain Gupta, MD
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| Veerain Gupta presented a SEER-Medicare analysis showing that NMIBC treatments vary substantially in time toxicity, measured as healthcare contact days in the year after diagnosis. Among 32,934 Medicare patients, median contact days were lowest with TURBT alone and highest with cystectomy, while intravesical chemotherapy and BCG added additional contact burden versus TURBT alone.
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