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Chaired by Ashish Kamat, MD, MBBS, the 5th annual AUA-IBCG Bladder Cancer Forum brought together global experts, multidisciplinary perspectives, and patient-centered discussion around the evolving management of bladder cancer. Coverage from the session highlights key debates across NMIBC and MIBC, including multimodal treatment strategies, post-BCG sequencing, intermediate-risk disease management, MRI-based staging, biomarkers, and risk-adapted systemic therapy.
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Highlights from the 2026 AUA-IBCG Bladder Cancer Forum
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| Update from the International Bladder Cancer Group (IBCG)
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| Ashish Kamat, MD, MBBS, and Sarah Psutka, MD, MS, FACS
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| The IBCG update emphasized the group’s global, consensus-driven work across bladder cancer, including prior and upcoming focus areas such as BCG-unresponsive NMIBC, bladder preservation in MIBC, biomarkers, toxicity assessment, and TURBT best practices. Sarah Psutka’s portion focused on the need for better, more patient-centered quality-of-life and toxicity tools, highlighting major gaps in current patient-reported outcome measures and the push to develop standardized bladder-cancer-specific instruments for trials and real-world care.
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| Trimodality Therapy for Muscle-invasive Bladder Cancer: Radiation, Responsibility – Who Manages the Fallout, and How?
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| Stephen Boorjian, MD, Janet Kukreja, MD, MPH, and Leslie Ballas, MD
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| At the 2026 AUA-IBCG Bladder Cancer Forum, a debate on trimodality therapy (TMT) for muscle-invasive bladder cancer highlighted differing views on managing radiation-related toxicity and who should lead post-treatment care. Janet Kukreja emphasized that toxicities are often chronic, under-recognized, and largely managed by urologists, while Leslie Ballas argued that, in appropriately selected patients, TMT offers favorable quality-of-life outcomes and that care should be shared across a multidisciplinary team. Both agreed that clear patient counseling and coordinated follow-up among urology, radiation oncology, and medical oncology are essential.
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| High-Risk NMIBC – BCG + IO – Progress or Overreach?
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| Mark Tyson,II, MD, MPH, Neal Shore, MD, FACS, and Morgan Rouprêt, MD, PhD
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| This AUA-IBCG Bladder Cancer Forum debate centered on whether adding systemic immunotherapy to BCG for BCG-naïve high-risk NMIBC is real progress or too much treatment for too little gain. Neal Shore argued the phase III data support BCG + IO for carefully selected high-risk patients, while Morgan Rouprêt countered that the benefits are modest, toxicity and cost are higher, and optimized BCG remains the better frontline standard for most patients.
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| Sequencing Therapies in BCG-Unresponsive, High-Risk NMIBC
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| Vignesh Packiam, MD, Amanda Myers, MD, MS, and Schmidt, MD, MPH
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| In this AUA-IBCG Bladder Cancer Forum debate on sequencing therapy for BCG-unresponsive high-risk NMIBC focused on whether gemcitabine/docetaxel should be the default first bladder-sparing option. Amanda Myers said it has become the de facto first-line choice because of durable control, low toxicity, low cost, and broad availability, while Bogdana Schmidt argued that no single therapy should be universal and that treatment should be individualized and sequenced based on disease features, patient priorities, and future options.
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| Best Practices for Intermediate-risk NMIBC
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| Mario Fernández, MD, Joan Palou, MD, and Akshay Sood, MD
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| As part of the 2026 AUA-IBCG Bladder Cancer Forum, the debate on intermediate-risk NMIBC centered on how aggressively to treat recurrent low-grade disease, especially after an initial TURBT. Akshay Sood favored de-intensified options like active surveillance, office fulguration, and chemoablative approaches for carefully selected patients, while Joan Palou argued that TURBT plus adjuvant intravesical therapy remains the most reliable standard, with treatment tailored to risk factors, tumor burden, and patient preference.
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| In 2026, MRI with VIRADS is Mandatory for the Staging and Therapeutic planning for Bladder Cancer
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| Niyati Lobo, MD, Patrick J. Hensley, MD, and Maria Carmen Mir, MD, PhD, FEBU,
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| At AUA 2026, the debate on bladder MRI with VI-RADS centered on whether it should be mandatory for staging and treatment planning in bladder cancer. Maria Carmen Mir argued it should be a foundational part of modern care because it improves local staging and multidisciplinary planning, while Patrick Hensley maintained that MRI is useful but still complementary, with TURBT and CT urography remaining essential standards for diagnosis, staging, and treatment selection.
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| Systemic Therapy in MIBC – Follow the Protocol or Use Risk Adapted Therapy?
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| Shilpa Gupta, MD, Félix Guerrero-Ramos, MD, PhD, FEBU, and Andrea Necchi, MD
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| This AUA-IBCG Bladder Cancer Forum debate in MIBC focused on whether patients should complete protocol-driven perioperative systemic therapy or switch to a risk-adapted strategy after a strong response. Andrea Necchi argued that sandwich perioperative therapy remains the standard, while Felix Guerrero-Ramos countered that ctDNA negativity, pT0 pathology, and treatment toxicity may justify omitting adjuvant therapy in selected patients.
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| Next Generation Markers – Is it Time to Let Go of our Old Friends?
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| Paolo Gontero, MD, Badrinath Konety, MD, MBA, and Maurizio Brausi, MD
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| This AUA-IBCG Bladder Cancer Forum debate focused on whether newer urinary biomarkers should replace or supplement older tools like cytology and cystoscopy in bladder cancer surveillance. Maurizio Brausi argued that next-generation markers are ready to reduce cystoscopy in selected patients, while Paolo Gontero countered that legacy markers still matter because many newer assays have lower PPV and limited ability to distinguish high-grade disease, so the best approach is to use both as complementary tools.
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