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, J.L. Dominguez Escrig, B. Peyronnet, T. Seisen, 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/?type=panel/.

1.3.Available publications

A quick reference document (Pocket guidelines) is available, both in print and as an app for iOS and Android devices. These are abridged versions which may require consultation together with the full text version. Several scientific publications are available, the latest publication dating to 2019 [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 2020 NMIBC Guidelines document presents a limited update of the 2019 publication.

1.4.2.Summary of changes

Additional data has been included throughout this document text. In particular in sections:

  • 4.7 - Variants of urothelial carcinoma and lymphovascular invasion: this section has been expanded to include further information on variant histologies.
  • 7.3 - Treatment of failure of intravesical therapy. This section has been considerably expanded, alongside a revision of Figure 7.2, Table 7.2 (Categories of unsuccessful treatment with intravesical BCG) and 7.7 Guidelines for the treatment of BCG failure.

Recommendations have been changed in sections:

7.5 Guidelines for adjuvant therapy in TaT1 tumours and for therapy of carcinoma in situ

General recommendations

Strength rating

Offer a RC to patients with BCG unresponsive tumours (see Section 7.7).

Strong

Offer patients with BCG unresponsive tumours, who are not candidates for RC due to comorbidities, preservation strategies (intravesical chemotherapy, chemotherapy and microwave-induced hyperthermia, electromotive administration of chemotherapy, intravesial- or systemic immunotherapy; preferably within clinical trials).

Weak

7.7 Guidelines for the treatment of BCG failure

Category

Treatment options

Strength rating

BCG-unresponsive

1. Radical cystectomy (RC)

Strong

2. Enrollment in clinical trials assessing new treatment strategies.

Weak

3. Bladder-preserving strategies in patients unsuitable or refusing RC.

Weak

Late BCG relapsing: T1Ta/HG recurrence
> 6 months or CIS > 12 months of last BCG exposure

1. Radical cystectomy or repeat BCG course according to individual situation.

Strong

2. Bladder-preserving strategies

Weak

LG recurrence after BCG for primary

1. Repeat BCG or intravesical chemotherapy

Weak

2. Radical cystectomy

Weak

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