Sam S. Chang, MD
The American Urological Association (AUA), together with the Society for Urologic Oncology (SUO), has released a new clinical practice guideline on non–muscle-invasive bladder cancer. This new document outlines guidance on a variety of topics, including diagnosis and treatment, as well as a risk-stratified clinical framework for postsurgical management of this disease. The guideline was presented at the 2016 AUA Annual Meeting in San Diego, California.
While the survival rate for the majority of patients with non–muscle-invasive bladder cancer is favorable, certain clinical and pathologic factors can impact overall prognoses and long-term outcomes. This new AUA/SUO document outlines steps that practitioners can take prior to and following transurethral resection of bladder tumor to better predict and manage disease progression.
Specifically, the guideline makes recommendations in the following areas:
- Diagnosis (including the role of cystoscopic examination, biopsy and cytology, upper tract imaging, and visual resection)
- Risk stratification and pathologic predictors (including variant histologies, cytology, and urinary biomarkers)
- Surgical intervention (including timing, techniques, goals, and indications for transurethral resection of bladder tumor/repeat resection; as well as the role of enhanced cystoscopy and cystectomy)
- Intravesical therapy (bacillus Calmette-Guérin/maintenance; combination therapies)
- Bacillus Calmette-Guérin relapse and salvage regimens
- Risk-adjusted surveillance and follow-up strategies
“We’ve come a long way in understanding bladder cancer and how to treat and manage this disease, and this guideline takes our knowledge one step further by refining our approach and allowing us to provide more individualized treatment to our patients,” said Sam S. Chang, MD, leader of the panel who developed the guideline and a urologic surgeon/oncologist and Patricia and Rodes Hart Professor of Urologic Surgery at Vanderbilt-Ingram Cancer Center. “Determining a patient’s risk of recurrence and/or progression is an essential part of managing bladder cancer, and this panel has attempted to integrate disease characteristics and treatment response. We hope this proves helpful for both treating physicians and patients.”
The full guideline is available online at www.AUAnet.org/Guidelines. ■
