4th NEEM in Riga: key messages in non-muscle invasive bladder cancer session

High-risk non-muscle invasive bladder cancer (NMIBC) took centre stage in the second plenary session during the two-day North Eastern European Meeting (NEEM) held in Riga, Latvia over the weekend.

Dr. Jeorg Schmidbauer (Vienna, Austria) lectured on the early detection of high risk non-muscle invasive bladder cancer. He discussed various techniques in detecting NMIBC such as optical coherence tomography (OCT), photodynamic diagnosis (PDD) and narrow band imaging (NBI), amongst other techniques.

In his take-home messages, Schmidbauer highlighted the following:

• OCT aim at providing a real-time, minimally invasive objective prediction of histopathologic diagnosis, while PDD and NBI aim at improving visualisation of bladder tumours.
• For OCT and NBI more research has to be conducted before these techniques can be implemented in daily practice.

Treatment options

Meanwhile, Feliksas Jankevicius (Vilnius, Lithuania) spoke on treatment options for high risk NMIBC.

Jankevicius mentioned the novel resectoscope with a lateral rotating motion, a technique which he said requires more studies. Regarding adjuvant intravesical chemotherapy, Jankevicius said it does not provide long-term benefits and therefore intravesical chemotherapy is not recommended for patients with long-term progression.

He then posed the question whether the increasing use of intravesical therapies in non-muscle invasive bladder cancer really has an impact on the survival of patients, a query which he said the answer is not really positive in the light of recent research.

In his key messages, Jankevicius mentioned the following:

• Radical cystectomy is the preferred treatment option for patients with BCG failure given the poor long-term response rates of salvage intravesical treatments.
• Salvage intravesical therapy continues to have a significant role in managing patients who are poor surgical candidates or those who refuse radical surgery;
• The timing and choice of intervention are ultimately determined by the patient’s individual risk profile and the treating physician’s own clinical experience.