Diane Z. Quale
A first-ever collaboration between the American Urological Association (AUA) and other prominent urological groups has created a multidisciplinary set of guidelines on treating patients with nonmetastatic muscle-invasive bladder cancer (MIBC).1
These new guidelines provide a riskstratified clinical framework so that urologists and oncologists treating patients with MIBC can better diagnose, treat, and manage the disease.
“Approximately 25% of newly diagnosed patients have muscle-invasive disease, and that rate hasn’t changed over the past 25 years. In addition, the overall prognosis of patients with muscle-invasive disease has not changed in the last 30 years and is primarily based on stage,” said Jeffrey M. Holzbeierlein, MD, who served as a panelist for formation of the guidelines. He is director of urologic oncology at the University of Kansas Medical Center, in his presentation of the guidelines.
Figure. Estimated New Genitourinary Cancer Cases and Deaths in the United States, 20172
Initial Evaluation and Counseling
The first series of guidelines includes statements regarding the need for staging evaluation during physical examination of patients under anesthesia. “The panel felt that this was an important component of identifying patients [whose tumors] might be resectable, and, of course, you would do this if you suspect MIBC at the time of [transurethral resection of bladder tumor (TURBT)]. Also, since there are a lot of comorbidities, this is a critical component to assess patients to determine what they might be candidates for in terms of treatment,” Holzbeierlein said.
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