Multimodal Management of Invasive Bladder Cancer in the Elderly
Acapulco, GRO, Mexico (UroToday.com) Life expectancy in general population is increasing, making more frequent the presentation of bladder cancer in the elderly population. The treatment for octogenarians is the same, cystectomy and perioperative chemotherapy in selected cases, nevertheless, there are more conservative options such as partial cystectomy, transurethral resection of the bladder (TURB) plus chemotherapy, radiotherapy alone and trimodal therapy (TMT). Wassim Kassouf, MD emphasized that chronological age alone should not be used to exclude patients from definitive therapy, the appropriate decisions should incorporate the functional status and comorbidities, patient desire and goals, and informed understanding of the risk and benefits.
Enhanced Recovery After Surgery, Radical Cystectomy and Urinary Diversion
Acapulco, GRO, Mexico (UroToday.com) The muscle-invasive bladder cancer affects the elderly population, and the gold standard treatment is a morbid procedure and is associated with a prolonged inpatient stay, in the USA, the median inpatient stay is 8-9 days, in Europe and Asia are 15-20 days. Ashish Kamat, MD stated there isn´t any preparation or training for the patient to such physical challenge.
Is Active Surveillance the New Paradigm?
Acapulco, GRO, Mexico (UroToday.com) Karim A. Touijer, MD provided a discussion about active surveillance (AS) in the treatment of prostate cancer. In randomized studies it has been shown that this therapy is a safe approach in patients with prostate cancer as well as radiotherapy and surgery, however, it only represents 6-8% of treatment of prostate cancer overall.
Biomarkers in Immunotherapy for Bladder Cancer
Acapulco, GRO, Mexico (UroToday.com) Clinical judgment/data is the key to predicting the response of intravesical BCG, actually, no biomarker can supersede our clinical data. Ashish Kamat, MD explains four biomarkers we could use to identify response to immunotherapy: PD-L1 status, molecular subtyping, tumor mutational burden and immune gene expression profiling.
Issues and Controversies in Upper Tract Urothelial Carcinoma
Acapulco, GRO, Mexico (UroToday.com) Eduardo Gonzalez-Cuenca, MD pointed out the important relation between Lynch syndrome and upper tract urothelial carcinoma (UTUC), with a cumulated risk of developing UTUC during a lifetime of these patients of 1-28%. In a recent series, it was found that 5% of UTUC patients have this syndrome and the importance is: highest frequency of colorectal cancer and that MSI-high UTUC tumors have greater sensitivity to checkpoint blockade and chemotherapy sensitivity.
When to Move to Radical Cystectomy for NMIBC
Acapulco, GRO, Mexico (UroToday.com) “When NOT removing the bladder would represent loss of an opportunity to CURE the patient” was the opening statement of Dr. Kamat’s conference.
The indications for radical cystectomy for NMIBC are: no respectability (large tumor in diverticulum), non functioning bladder and high risk bladder cancer (any T1 or high grade, including CIS; progresion rate of 25-50% @ 5 years).
Optimizing BCG Therapy for NMIBC
Acapulco, GRO, Mexico (UroToday.com) Dr. Kamat starts his conference stating that bladder cancer immunotherapy treatment, including written literature, seems only to include systemic therapy and not BCG. Actually BCG is the original cancer immunotherapy, the most effective for NMIBC and approximately 1.2 million doses are used globally.