In the United States, it is estimated that there will be 83,190 new cases of bladder cancer and 16,840 bladder cancer-related deaths in 2024. Approximately 25% of newly diagnosed patients are found to have muscle-invasive disease, a statistic that has remained relatively unchanged over the past decade according to data from the Surveillance, Epidemiology, and End Results (SEER) registry. Additionally, the guideline authors note, up to 50% or more patients with high-risk non-muscle invasive bladder cancer (NMIBC) may progress to invasive disease.
In observance of Bladder Health Awareness Month 2024, we will be examining the latest guideline on Diagnosis and Treatment Non-Muscle Invasive Bladder Cancer (NMIBC). This discussion will explore the key insights and recommendations outlined in the 2024 guidelines from the American Urological Association (AUA) and the Society of Urologic Oncology (SUO), as well as the 2024 amendment. Please be aware that this summary does not cover all major points, and for a comprehensive list of recommendations, you can refer to the summary provided or access the full text guidelines. Let us now commence with our discussion.
Key Takeaways
- Risk Stratification:
- Patients are stratified into low-, intermediate-, and high-risk groups based on clinical and pathologic factors to guide treatment decisions and improve outcomes.
- Variant Histologies:
- New recommendations have been established for managing variant histologies, which represent less common forms of bladder cancer. It is advised that an experienced genitourinary pathologist review the pathology of patients with any uncertainty regarding variant or suspected variant histology.
- Transurethral Resection of Bladder Tumor (TURBT):
- There is a strong emphasis on restaging Transurethral Resection of Bladder Tumor (TURBT) to ensure accurate assessment of the tumor. When considering a bladder-sparing approach for patients with variant histology, clinicians are recommended to conduct a restaging TURBT within four to six weeks following the initial procedure.
- BCG Maintenance:
- Revised recommendations have been made for Bacillus Calmette-Guérin (BCG) maintenance therapy to optimize treatment outcomes.
- Upfront Cystectomy:
- The consideration of upfront cystectomy for aggressive variants of non-muscle invasive bladder cancer (NMIBC) is suggested to enhance patient outcomes.
- Enhanced Cystoscopy:
- Continued emphasis is placed on utilizing enhanced cystoscopy techniques to improve tumor detection. Clinicians are encouraged to offer Blue Light Cystoscopy (BLC) at the time of TURBT, if available, to enhance detection and reduce recurrence rates.
- Urine Markers:
- Updated guidance has been provided on the use of urine markers post-diagnosis to monitor for recurrence. In the surveillance of NMIBC, clinicians are advised not to rely solely on urinary biomarkers and should continue to perform cystoscopic evaluations.
- Future Directions:
- There is a significant emphasis on the need for higher quality evidence in future trials to enhance treatment strategies and enhance patient outcomes. As new treatment options for NMIBC are being explored, research should focus on optimizing the dosing, scheduling, and administration of currently utilized medications that have demonstrated efficacy.
These guidelines have been developed to prioritize the health and management of individuals diagnosed with bladder cancer. Through ongoing updates, AUA/SUO ensure that the most up-to-date and highest quality recommendations are consistently provided. This guideline aims to enhance clinicians’ capacity to assess and treat patients with NMIBC based on the latest available evidence.
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