The American Urologic Association (AUA), in partnership with the Society of Urologic Oncology (SUO) has released an amendment for 2026 to the Diagnosis and Treatment of Non–Muscle Invasive Bladder Cancer (NMIBC) Guideline, published in The Journal of Urology. The amendment introduces 40 new and updated recommendations regarding risk stratification, pathologic terminology, biomarkers, surveillance strategies, and treatment options.
“As the treatment landscape for non–muscle invasive bladder cancer continues to evolve, it is essential that clinical guidance reflects the latest evidence,” said Peter E. Clark, MD, Chair of the Guideline. “This amendment provides clinicians with practical recommendations that support individualized decision-making while addressing emerging therapeutic approaches and ongoing advances in the field.”
Guideline Updates
Updates to the guidelines reflect a comprehensive review of newly published literature through December 2025 found through a systematic search of Ovid MEDLINE and Embase. The search identified 2,933 studies, and 71 of these studies met inclusion criteria.
Among the new and updated recommendations include new bladder-preserving options that may help select patients with recurrent low-grade disease avoid surgery. Bladder-preserving options include active surveillance, office-based treatment, and chemoablative therapies.
Risk stratification was updated to help clinicians better tailor treatment, surveillance, and follow-up plans according to a patient's individual risk of recurrence and progression.
Discussion of urinary biomarkers and emerging therapies was expanded to include options for patients with disease unresponsive to bacillus Calmette-Guérin.
The guideline amendment also includes new guidance for managing high-risk disease involving the prostatic urethra as well as recommendations for the timing, technique, goal, and induction of transurethral resection of bladder tumor, or a repeat resection.
“The field of non–muscle invasive bladder cancer continues to evolve rapidly, with new therapies and management approaches expanding options for patients and clinicians,” said Adam S. Kibel, MD, President of SUO. “These updated recommendations reflect the latest evidence and underscore the importance of individualized, risk-based care. By incorporating emerging research and practical treatment strategies, this guideline will help urologists make informed decisions that optimize patient outcomes.”
DISCLOSURES: For full disclosures of the study authors, visit auajournals.org.
