Non-muscle-invasive Bladder Cancer

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

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M. Babjuk (Chair), M. Burger (Vice-Chair), E. Compérat, P. Gontero, A.H. Mostafid, J. Palou, B.W.G. van Rhijn, M. Rouprêt, S.F. Shariat, R. Sylvester, R. Zigeuner
Guidelines Associates: O. Capoun, D. Cohen, V. Hernández, V. Soukup

1.INTRODUCTION

1.1.Aim and scope

This overview represents the updated European Association of Urology (EAU) guidelines for Non-muscle-invasive Bladder Cancer (NMIBC), TaT1 and carcinoma in situ (CIS). The information presented is limited to urothelial carcinoma, unless specified otherwise. The aim is to provide practical recommendations on the clinical management of NMIBC with a focus on clinical presentation and recommendations.

Separate EAU guidelines documents are available addressing upper tract urothelial carcinoma (UTUC) [1], muscle-invasive and metastatic bladder cancer (MIBC) [2], and primary urethral carcinoma [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. Guidelines are not mandates and do not purport to be a legal standard of care.

1.2.Panel composition

The EAU Guidelines Panel on NMIBC consists of an international multidisciplinary group of clinicians, including urologists, uro-oncologists, a pathologist and a statistician. Members of this panel have been selected based on their expertise and to represent the professionals treating patients suspected of suffering from bladder cancer. 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: https://uroweb.org/guideline/non-muscle-invasive-bladder-cancer/.

1.3.Available publications

A quick reference document (Pocket guidelines) is available, both in print and in a number of versions for mobile devices, presenting the main findings of the NMIBC Guidelines. These are abridged versions which may require consultation together with the full text version. Several scientific publications are available, the latest publication dating to 2016 [4], as are a number of translations of all versions of the EAU NMIBC Guidelines. All documents are accessible through the EAU website Uroweb: https://uroweb.org/guideline/non-muscle-invasive-bladder-cancer/.

1.4.Publication history and summary of changes

1.4.1.Publication history

The EAU Guidelines on Bladder Cancer were first published in 2000. This 2017 NMIBC guidelines document presents a limited update of the 2016 publication.

1.4.2.Summary of changes

New references have been added throughout the 2017 NMIBC Guidelines document.

Key changes in this 2017 print:

  • Section 4.3 - T1 subclassification. This is a new section.
  • Section 5.5 - Urinary Cytology. Diagnostic categories based on the Paris Working Group Classification have been added.
  • Section 5.10.2 - Surgical and technical aspects of tumour resection. This section has been revised and enlarged, resulting in changes in the recommendations (Section 5.14).
  • Section 5.12 - Second resection. Additional literature has been included, resulting in changes in the recommendations (Section 5.14).
  • Section 6.4 - Subgroup of highest risk tumours. This is a new section.
  • Section 7.2.1.3.2 - Device-assisted intravesical chemotherapy. This is a new section.

Changes in recommendations

Section 5.9: A new recommendation has been added.

Recommendations for the primary assessment of NMIBC

GR

Repeat urine cytology in patients with suspicious initial cytology results.

C

Section 5.14: Additional information has been included.

Recommendations for transurethral resection of the bladder (TURB) and/or biopsies and pathology report

Perform en-block resection or resection in fractions (exophytic part of the tumour, the underlying bladder wall and the edges of the resection area). The presence of detrusor muscle in the specimen is required in all cases except for TaG1/LG tumours.

B

Perform a second TURB in the following situations:

after (suspicion of) incomplete initial TURB (in the case of any doubt about completeness of a TURB);

if there is no muscle in the specimen after initial resection, with exception of TaLG/G1 tumours and primary CIS;

In T1 tumours.

A

Register the results of a second TURB as it reflects the quality of the initial resection.

A

Section 7.5: A new recommendation have been included.

Recommendations for adjuvant therapy in TaT1 tumours and for therapy of CIS

GR

In patients with bacillus Calmette-Guérin failure, who are not candidates of radical cystectomy due to comorbidities, use preservation strategies (device-assisted instillations of chemotherapy, intravesical chemotherapy, intravesical immunotherapy).

C

Section 8.1: A new recommendation has been added.

Recommendations for follow-up of patients after transurethral resection of the bladder for NMIBC

GR

In patients initially diagnosed with TaLG/G1-2 bladder cancer, use ultrasound of the bladder during surveillance in case cystoscopy is not possible, or refused by the patient.

C

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