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PEER-TO-PEER CLINICAL CONVERSATIONS |
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Urine Tumor DNA as a Biomarker for High-Risk Bladder Cancer Recurrence and Guidance
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Roger Li, MD
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| Roger Li speaks with Sam Chang about minimal residual disease detection using urinary tumor DNA in non-muscle invasive bladder cancer. Dr. Li explains why previous urine biomarkers failed to reach clinical use; they lacked actionability and sufficient positive predictive value.
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Assessment of Urine-Based Tests and Adjuncts in Bladder Cancer Guidelines
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Laura Bukavina, MD, MPH, MSc
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| Laura Bukavina discusses biomarker advances in bladder cancer surveillance and treatment, focusing on her team's comprehensive review. The surveillance domain explored blue light cystoscopy implementation, AI-assisted tumor detection during cystoscopy, and AI-enhanced cytology interpretation to address institutional variability and access issues.
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Predictive Biomarkers and Liquid Biopsies in Bladder Cancer
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David McConkey, PhD
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| Ashish Kamat speaks with David McConkey about predictive biomarkers in bladder cancer. Dr. McConkey explains why bulk molecular subtyping and DNA mutation analysis from the S1314 trial failed to validate earlier observations, attributing this to tumor heterogeneity and plasticity.
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| Upstaging and Risk Migration with Blue Light Cystoscopy for Non-Muscle-Invasive Bladder Cancer: Results from a Prospective Multicenter Registry
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| Alireza Ghoreifi, MD
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| Blue light cystoscopy led to upstaging or risk-group migration in about 9% of patients with non–muscle-invasive bladder cancer in this large prospective registry, including detection of malignant lesions missed by white light alone. These findings frequently shifted management, prompting initiation or intensification of intravesical therapy and, in some cases, consideration of radical cystectomy.
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| The 2025 AUA Hematuria Guidelines: Overview of Recommendations and Risk Stratification
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| Yair Lotan, MD
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| Hematuria is common but cancer risk is highly variable, so the 2025 AUA/SUFU hematuria guidelines refine risk stratification, labeling the lowest tier as “low/negligible risk” and recommending repeat urinalysis within six months instead of immediate cystoscopy or imaging in this group. Intermediate- and high-risk patients should undergo risk-based evaluation with cystoscopy and appropriate upper tract imaging, while urine markers and cytology are reserved mainly for select intermediate-risk patients who wish to defer cystoscopy, with ongoing emphasis on improving referrals so bladder cancer is detected at the microscopic rather than gross hematuria stage.
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| Costs of Care and Oncologic Outcomes Associated with Blue Light Cystoscopy in an Equal Access Setting: Results from the BRAVO Study
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| Ali Nasrallah, MD
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| In a large VA cohort with equal access to care, blue light cystoscopy (BLC) for NMIBC was associated with fewer recurrences but higher 5‑year total and outpatient costs compared to white light alone. However, when accounting for the expenses of managing recurrences and reduced healthcare utilization, BLC approached cost-neutrality over 5 years, suggesting improved oncologic outcomes with only a modest long-term cost premium.
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| What Constitutes an Optimal TURBT in 2025?
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| Vignesh Packiam, MD, and Mark Tyson, MD, MPH
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| An optimal TURBT in 2025 is defined less by any single device and more by a meticulous surgeon using contemporary technology to completely resect all visible tumor with detrusor muscle, accurately document and map disease, and minimize complications. High‑quality technique plus enhanced tools (bipolar/en bloc resection, blue light cystoscopy, improved visualization) are jointly driving better NMIBC outcomes, with more complete resections, improved staging, and lower recurrence—though blue light reduces recurrence rather than demonstrating an overall survival benefit.
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Impact on Oncological Outcomes of Detrusor Muscle Absence in pTaHG Urothelial Carcinoma of the Bladder? the End of the "Jump" of the Lamina Propria Layer Myth - Beyond the Abstract
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| Gabrielle Tissot, MD
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| In a real-world multicenter cohort of 418 patients with pTa high-grade non–muscle-invasive bladder cancer, absence of detrusor muscle in the initial TURBT specimen did not increase 5‑year risks of recurrence or progression. Re-TURBT also failed to improve progression-free survival in those without muscle in the first resection, challenging the dogma that tumor cells “jump” the lamina propria and calling into question routine second resection solely for missing detrusor in pTaHG disease.
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