CUOS 2019: Bladder Preservation for Invasive Bladder Cancer: Lessons Learned and Future Perspectives

Toronto, Ontario ( In this discussion, the topic of bladder preservation was presented by Dr. Huddart from the Royal Marsden NHS Foundation Trust in the United Kingdom.

Muscle invasive bladder cancer, after diagnosis using TURBT, is usually treated with radical cystectomy with the option of neoadjuvant chemotherapy before surgery. However, another option is treatment with Radiotherapy with or without chemotherapy (radiosensitizer). These patients are then followed with cystoscopy, which can then lead to either salvage radical cystectomy for residual/recurrent invasive disease, or another TURBT with local treatment for the superficial disease recurrence.

CUOS 2019: High-grade Upper Tract Urothelial Carcinoma – Adjuvant Chemotherapy

Toronto, Ontario ( In this debate, Dr. Rodney H. Breau supported the administration of adjuvant chemotherapy over neoadjuvant chemotherapy in upper tract urothelial carcinoma (UTUC).

Dr. Breau began with two statements that according to him, everyone can agree upon:

CUOS 2019: High-grade Upper Tract Urothelial Carcinoma – Neoadjuvant Chemotherapy

Toronto, Ontario ( Dr. Kala S. Sridhar participated in a debate and supported the use of neoadjuvant chemotherapy instead of adjuvant chemotherapy for high-grade upper tract urothelial carcinoma (UTUC).

UTUC is a rare disease involving the renal pelvis and ureter. High-grade disease is usually treated with radical nephroureterectomy, with a 5-year cancer-specific survival of less than 50% for pT3 disease, 5-10% for pT4 disease, and less than 35% for the pN+ disease. Perioperative chemotherapy plays an important role in the treatment of this high-grade disease.

CUOS 2019: Neoadjuvant Chemotherapy Guided by Molecular Subtyping

Toronto, Ontario ( Dr. Peter Black presented on why we need to use molecular subtyping to decide which patients with muscle-invasive bladder cancer should get neoadjuvant chemotherapy before radical cystectomy.

CUOS 2019: Neoadjuvant Chemotherapy for All Muscle-Invasive Bladder Cancer

Toronto, Ontario ( Dr. Nimira Alimohamed presented her opinion of the question in debate: neoadjuvant chemotherapy for all muscle-invasive bladder cancer versus neoadjuvant chemotherapy guided by molecular subtyping.  Dr. Alimohamed believes all medically fit patients with muscle-invasive bladder cancer should be offered neoadjuvant chemotherapy before radical cystectomy. Furthermore, she strongly believes that neoadjuvant chemotherapy should not be guided by molecular subtyping at this point. Neoadjuvant chemotherapy has been shown to confer a survival benefit with a difference of more than 30 months (77 vs. 46 months).1 There are, however, still several unresolved issues with the current standard of care:

CUOS 2019: Robotic Radical Cystectomy, Controversial Topics in Urothelial Carcinoma

Toronto, Ontario ( Radical cystectomy is the gold standard surgical therapy for muscle-invasive bladder cancer and refractory non-muscle invasive bladder cancer. Open radical cystectomy is a highly morbid procedure, with a very extended recovery period. Robotic radical cystectomy is a procedure with a potentially faster recovery period, with potential greater benefit to the patients and the surgeon.

CUOS 2019: Open Radical Cystectomy, Controversial Topics in Urothelial Carcinoma

Toronto, Ontario ( Dr. Adrian Fairey provided his discussion supporting the use of open radical cystectomy instead of robotic radical cystectomy for the treatment of muscle-invasive bladder cancer. According to Dr. Fairey, open radical cystectomy is the standard of care surgical treatment modality for bladder cancer. In the Canadian universal healthcare system in 2019, robotic cystectomy should not be recommended as a surgical treatment modality outside of a clinical trial.
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