AUA 2018: Medium Size Bladder Tumors En-block Bipolar Resection on Put to the Test
San Francisco, CA (UroToday.com) The conventional transurethral resection of bladder tumor (TURBT) technique involves piecemeal resection of the tumor, which is contrary to the established oncological principles of cancer surgery. En-block TURBT has been championed as a superior technique since the tumor is left intact during resection which leads to improved pathological evaluation and improved recurrence rates. Dr. Geavlete, from Bucharest Romania, presents a long-term, prospective, randomized-controlled trial aimed at comparing the clinical outcomes of patients with medium size papillary non-muscle invasive bladder tumors (NMIBT) treated with either standard or en-block bipolar resection TURBT.
AUA 2018: Purified Protein Derivative Skin Test Prior to BCG Therapy Enhances the Clinical Efficacy of BCG Therapy in Patients with NMIBC
San Francisco, CA (UroToday.com) Intravesical BCG acts as an immune modulator which elicits a local immune response which has been found to prevent the risk of recurrence and progression in patients with intermediate and high risk non-muscle invasive bladder cancer. The effectiveness of BCG for the management of bladder cancer is variable with 30-50% patients failing treatment. Several adjunctive therapies have been attempted to boost BCG immune response with little success. Dr. Niwa, from Kio University in Tokyo Japan, presents the effectiveness of prior treatment with Purified Protein Derivative (PPD) in patients treated with intravesical BCG.
AUA 2018: Correlation between Surgeon’s Experience and Pathological and Oncological Outcomes after Transurethral Resection of the Bladder
San Francisco, CA (UroToday.com) Oncological outcomes for patients with non-muscle invasive bladder cancer (NIMBC) have been significantly correlated with the quality of the transurethral resection of the bladder tumor (TURBT). A quality TURBT is defined as one that removes all visible lesions, with the presence of adequate detrusor muscle for accurate staging. Several reports have shown that surgeon experience as the most important factor associated with pathological quality assessment and superior clinical outcomes (recurrence and progression rates). Dr. Naspro, from Bergamo Italy, presents a multi-institutional retrospective review aimed to assess the correlation between the surgeon's experience and the pathological and oncological outcomes of NIMBC undergoing a TURBT at 4 high volume centers.
AUA 2018: Switching of Bacillus Calmette-Guerin Strain at Second BCG Therapy May Reduce BCG-Related Side Effects in Patients with BCG-Relapsing Tumors
San Francisco, CA (UroToday.com) Currently, two strains of Bacillus Calmette-Guerin (BCG) (Tokyo-172 and Connaught) are used for the treatment of patients with high-risk non-muscle invasive bladder cancer. Recent studies have proposed that BCG resistance may be related to the type of strain used. Some have advocated that resistance may be secondary to clonal selection from the specific strain used, arguing that treatment with a different strain may rescue patients who have had an initial response to BCG (BCG relapsing). Dr. Niwa, from Keio University in Tokyo Japan, presents a retrospectives study which evaluates the clinical efficacy and safety of switching of BCG strain at the second BCG therapy in patients with BCG-relapsing non-muscle-invasive bladder tumor, defined as recurrence after achieving a disease-free status for 6 months.
AUA 2018: Patient Centered Outcomes of Intravesical BCG Plus Interferon
San Francisco, CA (UroToday.com) The ongoing Phase 2 BCG/IFN national trial is a trial evaluating the efficacy and primarily the safety of BCG and concurrent IFN (interferon) for the treatment of BCG-naïve and BCG-refractory NMIBC (non-muscle invasive bladder cancer). In detail, patients were treated with full dose BCG for BCG naive (BCG-N), 1/3 dose BCG for prior BCG failures (BCG-F), and 1/10 dose BCG for patients deemed BCG intolerant (BCG-I)) plus IFN for 6 weekly treatments.
AUA 2018: Accurate Prediction of Progression to Muscle Invasive Disease in Patients with T1G3 Bladder Cancer: A Clinical Decision-Making Tool
San Francisco, CA (UroToday.com) NMIBC represents approximately 70% of all bladder cancer diagnoses. While low-grade disease has high rates of recurrence and low rates of progression, patients with CIS and high-grade (HG) disease have high rates of progression to muscle-invasive bladder cancer. Early definitive therapy and more aggressive interventions may help alter the natural history of the disease and provide curative options for these patients.
AUA 2018: Prospective Validation of a Diagnostic Urine Test For Bladder Cancer: The HEMAturia Study
San Francisco, CA (UroToday.com) Kim van Kessel, MD, presented a validation study of a urine-based diagnostic assay for bladder cancer: The HEMAturia study. The authors have previously published their findings on this test using a discovery cohort and retrospective validation cohort, reporting >90% sensitivity and 83-85% specificity.1,2 However, as those were both case enriched, they are moving to a prospective cohort.