The 2026 amendment adds 40 new recommendations, including active surveillance, office-based treatment, and chemoablation for select recurrent low-grade disease.
The American Urological Association (AUA) and the Society of Urologic Oncology (SUO) have released a 2026 amendment to the Diagnosis and Treatment of Non-Muscle Invasive Bladder Cancer Guideline, updating recommendations on risk stratification, biomarkers, surveillance, and bladder-preserving therapy for patients with non–muscle-invasive bladder cancer (NMIBC), according to a news release from the AUA.1 The amendment was also published in The Journal of Urology.2
The amendment introduces 40 new recommendations alongside revisions to risk stratification, pathologic terminology, biomarkers, surveillance strategies, and treatment options.1 New additions include recommendations supporting active surveillance, office-based treatment, and chemoablative therapy for select patients with recurrent low-grade disease, as well as guidance for managing high-risk disease that involves the prostatic urethra.
NMIBC accounts for approximately 80% of newly diagnosed bladder cancer cases in the United States and requires ongoing monitoring and treatment.
“As the treatment landscape for non-muscle invasive bladder cancer continues to evolve, it is essential that clinical guidance reflects the latest evidence,” Peter E. Clark, MD, chair of the guideline, stated in a news release. “This amendment provides clinicians with practical recommendations that support individualized decision-making while addressing emerging therapeutic approaches and ongoing advances in the field.”¹
Updates were made to NMIBC risk stratification and to guideline statements on biomarkers, subtype histologies, transurethral resection, intravesical therapy, BCG maintenance, enhanced cystoscopy, and future directions.2 The revised risk stratification is intended to help clinicians tailor treatment and follow-up to each patient’s individual cancer risk, and an expanded discussion of urinary biomarkers addresses their role in assessing treatment response.1
For select patients with recurrent low-grade disease, the amendment adds bladder-preserving options—active surveillance, office-based treatment, and chemoablative therapy—that may allow some patients to avoid surgery.
The amendment also discusses emerging therapies and newly published research, including treatment options for patients with BCG-unresponsive disease.
“The field of NMIBC continues to evolve rapidly, with new therapies and management approaches expanding options for patients and clinicians,” Adam S. Kibel, MD, president of the SUO, said in the news release. “These updated recommendations reflect the latest evidence and underscore the importance of individualized, risk-based care.”¹
Investigators used a modified version of the original guideline search strategy to conduct a systematic search of Ovid MEDLINE and Embase for evidence published between May 2023 and December 2025.2 The modified search added keywords for newly added therapeutic agents in accordance with the updated populations, interventions, comparators, and outcomes.
The search identified 2933 studies, 71 of which met inclusion criteria following title and abstract screening. After full-text review, 38 studies were included in the final evidence base.² The amendment was developed by a panel of experts in urologic oncology, and the methodology and reference sections were revised as appropriate.1,2
