AUA 2017:Non-Muscle Invasive Bladder Cancer Guidelines
Dr. Ribel began with basic epidemiology of bladder cancer with high mortality and costs of 4.9 billion euros (making it the most expensive cancer per patient). She suggested that most of the cost is derived from surveillance. The EAU recommends a risk-adaptive approach for treatment and especially for followup. EORTC and Cueto both offer recurrence and progression calculators. She underscored that the first cystoscopy at 3 mos post TURBT has important prognostic information and should not be omitted. She reminded the audience that prompt detection of MIBC is crucial because delay in therapy is life threatening. However, recurrence in low risk NMIBC is nearly always low grade, so early detection is not essential. Upper tract surveillance should be risk adapted as well. Low risk tumors almost never recur after 5 years. Because of these facts, the EAU recommends annual cystoscopic surveillance for low risk patients, ending at five years, but lifelong and more frequent surveillance for high risk patients (q3mo x 2 years, q6mo x 5 years, then yearly for life.
Dr. Boorjian reviewed the AUA/SUO guidelines reported by Chang et al in J Urol 2016. Risk stratification was a key new aspect of these guidelines with the goal of Identifying and avoiding undertreatment of high risk patients. High risk was defined by any high grade, but also bcg failure, any variant histology, LVI, or prostatic urethral involvement. They recognize the low response of these patients to BCG and advise consideration of early cystectomy in these patients. Initial response rate to BCG is 70%, second induction response rate is 35% and there is lack of benefit after 2 inductions. HGT1 tumors should be re-TURed even if muscle present due to 20% upstaging. They recommend the SWOG BCG schedule with 6 week induction, followed by q3mo maintenance for 3 years.
Presented by: Maria Ribal, Md/PhD University of Barcelona and Stephen Boorjian, MD Mayo Clinic
Contributed by: Jed Ferguson, MD/PhD and Ashish Kamat, MD. MD Anderson Cancer Center, Department of Urology.
at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA