AUA, ASCO, and SUO Publish 2024 Amendment to Nonmetastatic Muscle-Invasive Bladder Cancer Guidelines

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The American Urological Association (AUA), in partnership with ASCO and the Society of Urologic Oncology (SUO), has issued a 2024 clinical practice guideline amendment for the diagnosis and treatment of nonmetastatic muscle-invasive bladder cancer. The updated guidelines were published by Holzbeierlein et al in the Journal of Urology.


Current estimates suggest that there will be over 83,000 new cases of bladder cancer and nearly 17,000 bladder cancer–related deaths in 2024 in the United States. Up to 50% or more of patients with high-risk non–muscle-invasive bladder cancer can experience progression to invasive disease.

The male-to-female ratio is 3:1, and disease incidence may increase with age. Although rates of bladder cancer are higher in White patients than other racial and ethnic groups, disease-specific survival is often worse overall among Black patients.

Overview of 2024 Clinical Practice Guideline Amendment

The new amendment is a comprehensive update to the original 2017 guidelines, integrating revisions made in 2020 and 2024. The document underwent a rigorous peer-review process involving experts from various professional backgrounds, as conducted by the AUA.

The new amendment includes:

  • Updated text supporting statements on neoadjuvant/adjuvant chemotherapy, pelvic lymphadenectomy, and multimodal bladder-preserving therapy incorporating newly available data and updated discussion
  • Updated recommendations on adjuvant immunotherapy and considerations for organ-sparing procedures
  • A revised “Future Directions” section containing additional text on detection, therapeutics, and surveillance.


“The landscape for the management of muscle-invasive bladder cancer continues to change with the advent of new therapies, techniques, and adjuvant care,” emphasized lead guideline author Jeffrey M. Holzbeierlein, MD, former President of the SUO and Chair for the guideline amendment. “This amendment to the previous muscle-invasive bladder cancer guidelines will help clinicians appropriately manage these complex patients,” he added.

Disclosure: For full disclosures of the guideline authors, visit