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PEER-TO-PEER CLINICAL CONVERSATIONS |
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| AUA Microhematuria Guidelines 2025 |
| Daniel Barocas, MD, MPH, FACS, |
| Zachary Klaassen interviews Daniel Barocas on the AUA/SUFU microhematuria guideline update. Dr. Barocas explains that a systematic evidence review, multi‑panel consensus and layered peer scrutiny underpin the recommendations. |
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AI Risk Calculator Outperforms EAU Models for Bladder Cancer Prognosis
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Alexandre Zlotta, MD, PhD, FRCSC
Ashish Kamat is joined by Alexandre Zlotta to discuss the evolution of AI in bladder cancer management. Dr. Zlotta highlights work developing an AI model for non-muscle invasive bladder cancer risk assessment that significantly outperforms existing tools like the EAU risk calculator.
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| Bladder Cancer Risk Stratification Using Non-Coding RNA |
Yair Lotan, MD
Sam Chang hosts Yair Lotan to discuss non-coding RNA as a predictor of bladder cancer subtypes. Dr. Lotan describes a multicenter retrospective analysis of 230 cystectomy patients without neoadjuvant chemotherapy, focusing on identifying favorable subgroups within luminal tumors. |
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| A Multicenter Prospective Randomized Controlled Trial Comparing Cxbladder Triage to Cystoscopy in Patients with Microhematuria: The STRATA: Safe Testing of Risk for Asymptomatic Microhematuria Trial
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| Yair Lotan, MD
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| Yair Lotan presents the results from the STRATA trial, a multicenter randomized study comparing Cxbladder Triage (CxbT) to standard cystoscopy for patients with low-risk microhematuria. The study found that using CxbT significantly reduced unnecessary cystoscopies by 59%, with a 90% sensitivity and 99% negative predictive value, suggesting it’s a safe and effective triage tool. These results support incorporating Cxbladder into future guidelines for evaluating microhematuria.
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| Clinical Utility of a Urinary Biomarker (Cxbladder Triage) Compared to Standard of Care for Microscopic Hematuria Evaluations in a Large Independent Delivery Network |
| Christopher Filson, MD |
| Christopher Filson presents real-world data from Kaiser Permanente–Southern California showing that Cxbladder Triage significantly reduced unnecessary cystoscopies and CT scans in patients with low-risk microscopic hematuria, while appropriately increasing testing in higher-risk individuals. Among over 3,300 matched patients, Cxbladder testing led to a 92% relative reduction in cystoscopy use in low-risk patients without compromising cancer detection rates. |
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| A Urinary Biomarker to Triage Patients for Cystoscopy in Patients with Microhematuria - Expert Commentary |
| Bishoy Faltas, MD |
| Bishoy Faltas reviews a study evaluating Cxbladder Triage (CxbT) as a non-invasive tool to guide cystoscopy decisions in patients with microhematuria. The study showed that CxbT significantly reduced unnecessary cystoscopies—by 59% in lower-risk patients—while maintaining high sensitivity (90%) and a negative predictive value of 99% for urothelial carcinoma. |
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| Is There a Role for AI in Diagnosis and Risk Stratification for Bladder Cancer? |
| Hikmat Al-Ahmadie, MD, and Alexandre Zlotta, MD, PhD, FRCSC |
| Experts debated the role of AI in NMIBC risk stratification, highlighting promising advances in both clinical and pathological applications. Dr. Zlotta presented the PROGRxN-BCa model, which outperformed existing tools in predicting progression risk, while Dr. Al-Ahmadie emphasized how AI can enhance—but not replace—histologic evaluation. Post-debate polling showed increased support for integrating both clinical and pathological AI in NMIBC management. |
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| High-Precision Detection of Difficult-to-Detect Lesions in Bladder Cancer Diagnosis Using a Lightweight AI Model
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| Ryotaro Okazaki, MD
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| Ryotaro Okazaki presents a lightweight AI model that significantly improves real-time detection of difficult-to-identify bladder cancer lesions, including flat, small, and CIS lesions. By integrating EfficientNetV2 and U-Net architectures with a novel fusion of specialized models and loss functions, their system achieved high sensitivity (95.8%) and specificity (98.8%) while running efficiently on standard hardware.
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| Assessing Hematuria Screening Disparities Using the All of Us Database |
| Jonathan Ryan |
| Jonathan Ryan presents a study using the All of Us database that revealed significant racial and gender disparities in the evaluation of hematuria, an early indicator of genitourinary cancers. Women and racial minorities, particularly Hispanics in high-risk groups, were significantly less likely to receive recommended diagnostic evaluations like cystoscopy and imaging. The findings underscore the need to address social determinants of health—especially insurance status—and improve adherence to clinical guidelines to reduce inequities in bladder cancer screening. |
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