ASCO GU 2017: Optimizing Outcomes in Muscle-Invasive and Metastatic Bladder Cancer - Urologist Perspective - Session Highlights

Orlando, Florida USA ( Eugene Lee, University of Kansas, discussed the principles of surgery. Transurethral resection of the bladder tumor is of upmost importance. Resect all disease with wide margin with adequate muscle in the specimen. Examination under anesthesia provided vital information regarding concern for extravesical disease and pelvic fixation. Pathology report should have grade, stage with avoidance of ‘non-invasive’ in the report, documentation of whether muscle in specimen, histologic detail including presence or absence of lymphovascular invasion, CIS and/or variant histology.

Staging should include chest imaging (CXR or CT) and CT urogram to assess the lungs and upper tracts/pelvic disease, respectively. Up to 42-73% patients will be upstaged at radical cystectomy highlighting limitations of current imaging modalities. Accuracy is mildly improved with MRI at 60% of patients upstaged at radical cystectomy. In a prospective trial at MD Anderson assessing utility of MRI, sensitivity and specificity is 100% and 78%, respectively. FDG PET may be limited due to urinary excretion and may be best suited to those with equivocal disease with 20% patients upstaged. Determining which treatment is best suited for a patient can be defined as ‘fitness’ for radical cystectomy. Mortality 90-d with surgery ranges between 0-11% with significant morbidity in >50% reported. Frailty measures include unintentional weight loss, exhaustion, weak grip strength, slow walking speed, low physical activity with the Frailty index being a standardized instrument to measure frailty. Frailty has been associated with complications in patients undergoing radical cystectomy and may be the appropriate measure determining which patients are best suited for a particular treatment.

Presenter: Eugene Lee, University of Kansas Medical Center

Contributed by Stephen B. Williams, MD, Assistant Professor, Division of Urology, The University of Texas Medical Branch at Galveston, Galveston, TX and Ashish M. Kamat, MD, Professor, Department of Urology, The University of Texas MD Anderson, Houston, TX

at the 2017 Genitourinary Cancers Symposium - February 16 - 18, 2017 – Orlando, Florida USA