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PEER-TO-PEER CLINICAL CONVERSATIONS
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Debating First-Line Treatment for BCG-Unresponsive Bladder Cancer
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Bogdana Schmidt, MD, MPH, and Amanda Myers, MD, MS
Bogdana Schmidt and Amanda Myers discuss how clinicians are weighing available bladder-sparing approaches for BCG-unresponsive disease, including the role of intravesical chemotherapy, the limitations of non-comparative data, and the importance of patient preference, access, treatment burden, and cost in individualized treatment selection.
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BCG-Unresponsive Bladder Cancer Care in Community Practice
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Gautam Jayram, MD
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| Gautam Jayram discusses real-world challenges in delivering BCG-unresponsive bladder cancer therapies in community practice.
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Non-Surgical Management of Non-Muscle Invasive Bladder Cancer: Surveillance, Chemoablation, and Office-Based Approaches
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Katie Murray, DO, MS, FACS
Katie Murray discusses non-surgical management strategies for selected patients with NMIBC, including surveillance, chemoablation, and office-based approaches. She emphasizes the continued importance of high-quality TURBT while outlining how recurrence patterns, comorbidities, treatment burden, and shared decision-making may guide individualized care.
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| Real-World Outcomes of Bladder-Sparing Strategies for BCG-Unresponsive Nonmuscle-Invasive Bladder Cancer: A Multicenter Study
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| Pietro Scilipoti, MD
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| Pietro Scilipoti’s EAU 2026 study found that among patients with BCG-unresponsive NMIBC who were not undergoing cystectomy, gemcitabine/docetaxel and EMDA/MMC were both viable bladder-sparing options, with lower recurrence risk than repeat BCG. Still, radical cystectomy remained the guideline standard for eligible patients, and the authors called for prospective trials to better define sequencing.
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| Case-Based Panel Discussion High-Risk NMIBC Post-BCG Failure: Spare the Bladder? How Do Cystectomy and Bladder Sparing Compare When We Ask Patients?
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| Kathryn Gessner, MD, PhD
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| CISTO, the best prospective evidence so far, found similar physical functioning at 12 months for bladder-sparing therapy and radical cystectomy in patients with high-risk NMIBC after BCG failure. Bladder sparing had better bowel and sexual outcomes, while cystectomy had lower recurrence, better emotional and financial well-being, and no clear cancer-specific survival difference.
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| Patient Preferences, Treatment Received, and Quality of Life in the CISTO Study Comparing Radical Cystectomy or Bladder Sparing Therapy for Recurrent High-Grade NMIBC
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| Angela Smith, MD, MS
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| Angela Smith reports that most patients chose treatment aligned with their preference for retaining or removing the bladder, and radical cystectomy was more often chosen by those with higher certainty of cure. Overall, matching treatment to preference was not associated with better 12-month patient-reported outcomes, and many cystectomy patients reported unexpectedly good recovery and less anxiety.
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| Real-World Patterns and Clinical Outcomes Among US Patients with NMIBC During the BCG Shortage
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| Suzanne Merrill, MD, FACS
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| Suzanne Merrill’s presents a study which found that during the BCG shortage, only 29% of high-risk NMIBC patients received BCG induction and just 12% received maintenance, with shorter-than-recommended durations. High-risk patients had worse progression-free survival, cystectomy-free survival, and overall survival compared with lower-risk disease, underscoring the need for effective alternatives when adequate BCG cannot be delivered.
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