Muscle-invasive and Metastatic Bladder Cancer

Full Text Guidelines Summary of Changes Scientific Publications & Appendices Pocket Guidelines Archive Panel

To access the pdfs & translations of individual guidelines, please log in as EAU member.
Non-EAU members can view the web versions.
To become an EAU member, click here.

J.A. Witjes (Chair), E. Compérat, N.C. Cowan, G. Gakis, T. Lebrét, A.G. van der Heijden, M.J. Ribal
Guidelines Associates: M. Bruins, V. Hernández, E. Linares Espinós, J. Dunn, M. Rouanne, Y. Neuzillet, E. Veskimäe

1.INTRODUCTION

1.1.Aims and scope

The European Association of Urology (EAU) Guidelines Panel for Muscle-invasive and Metastatic Bladder Cancer (MIBC) has prepared these guidelines to help urologists assess the evidence-based management of MIBC and to incorporate guideline recommendations into their clinical practice.

Separate EAU guidelines documents are available addressing upper urinary tract tumours [1], non-muscle-invasive bladder cancer (Ta,T1 and carcinoma in situ) [2], and primary urethral carcinomas [3].

It must be emphasised that clinical guidelines present the best evidence available to the experts but following guideline recommendations will not necessarily result in the best outcome. Guidelines can never replace clinical expertise when making treatment decisions for individual patients, but rather help to focus decisions - also taking personal values and preferences/individual circumstances of patients into account.

1.2.Panel Composition

The EAU Guidelines Panel consists of an international multidisciplinary group of clinicians, including urologists, a pathologist, a radiologist and an oncologist.

All experts involved in the production of this document have submitted potential conflict of interest statements which can be viewed on the EAU website Uroweb: http://uroweb.org/guideline/bladder-cancer-muscle-invasive-and-metastatic/?type=panel.

1.3.Available publications

A quick reference document (Pocket Guidelines) is available, both in print and in a number of versions for mobile devices. These are abridged versions which may require consultation together with the full text version.

Several scientific publications are available (the most recent paper dating back to 2014 [4]), as are a number of translations of all versions of the EAU MIBC Guidelines. All documents are accessible through the EAU website: http://uroweb.org/guideline/bladder-cancer-muscle-invasive-and-metastatic/.

1.4.Publication history and summary of changes

1.4.1.Publication history

The EAU published its first guidelines on bladder cancer in 2000. This document covered both superficial (non-muscle-invasive) bladder cancer and MIBC. Since these conditions require different treatment strategies, it was decided to give each condition its own guidelines, resulting in the first publication of the MIBC guidelines in 2004. This 2016 document presents a limited update of the 2015 version.

1.4.2.Summary of changes

Key changes in this 2016 print:

Two new sections have been included:

Section 7.4.3.1 - What are the oncological and functional outcomes of sexual-function preserving cystectomy compared with standard radical cystectomy in men with bladder cancer? [5].

  • Section 7.4.3.2 - What are the oncological and functional outcomes of pelvic organ-preserving cystectomy compared with standard radical cystectomy in women with bladder cancer? [6].
  • Section 7.4.3.3 - Laparoscopic/robotic-assisted laparoscopic cystectomy, has been completely revised.

1.4.2.1.Changes in Summary of evidence and recommendations:

3.3.3 Recommendations for the assessment of tumour specimens

Recommendations

GR

Record the number of lymph nodes and number of positive lymph nodes.

A*

Record lymphatic or blood vessel invasion.

Record presence of CIS.

*Upgraded following panel consensus.

CIS=carcinoma in situ.

7.4.3.1.1 Summary of evidence and recommendations for sexual sparing techniques in men

Summary of evidence

The majority of patients motivated to preserve their sexual function will benefit from sexual-preserving techniques.

None of the sexual-preserving techniques (prostate/capsule/seminal/nerve sparing) have shown to be superior and no particular technique can be recommended.

Recommendations

LE

GR

Offer sexual-preserving techniques to men motivated to preserve their sexual function since the majority will benefit.

2

B

Select patients based on:

- Organ-confined disease;

- Absence of any kind of tumour at the level of the prostate, prostatic urethra or bladder neck.

2

A

Do not offer sexual-preserving cystectomy as standard therapy for MIBC.

C

MIBC=muscle-invasive bladder cancer.

7.4.3.2.4 Summary of evidence and recommendations for sexual sparing techniques in women

Summary of evidence

Data regarding pelvic organ-preserving radical cystectomy for female patients remain immature.

Recommendations

LE

GR

Offer sexual-preserving techniques to female patients motivated to preserve their sexual function since the majority will benefit.

3

C

Select patients based on:

Organ-confined disease;

Absence of tumour in bladder neck or urethra.

C

Do not offer pelvic organ-preserving radical cystectomy for female patients as standard therapy for MIBC.

C

MIBC=muscle-invasive bladder cancer.

7.4.3.3.1 Summary of evidence and recommendations for laparoscopic/robotic-assisted laparoscopic cystectomy

Summary of evidence

LE

RARC has a longer operative time (1-1.5 hours), major costs; but shorter LOS (1-1.5 days) and less blood loss compared to ORC.

1

RARC series suffer from a significant stage selection bias when compared to ORC.

1

Grade 3, 90-day complication rate is lower with RARC.

2

Most endpoints, if reported, including intermediate term oncological endpoint and QoL are not different between RARC and ORC.

2

Surgeons experience and institutional volume are considered the key factors for outcome of both RARC and ORC, not the technique.

2

Recommendations on how to define challenging patients and an experienced RARC surgeon are still under discussion.

3

The use of neobladder after RARC still seems under-utilised, and functional results of intracorporeally constructed neobladders should be studied.

4

Recommendations

GR

Inform the patient of the advantages and disadvantages of ORC and RARC to select the proper procedure.

C

Select experienced centres, not specific techniques, both for RARC and ORC.

B

Beware of neobladder under-utilisation and outcome after RARC.

C

LOS=length of hospital stay; ORC=open radical cystectomy; QoL=quality of life; RARC=robot-assisted radical cystectomy.

Top
×