1. INTRODUCTION
1.1. Aims and scope
This overview represents the updated European Association of Urology (EAU) Guidelines for Muscle-invasive and Metastatic Bladder Cancer (MIBC). The aim is to provide practical recommendations on the clinical management of MIBC with a focus on clinical presentation. Separate EAU guidelines are available addressing upper urinary tract (UUT) tumours [1], non-muscle-invasive bladder cancer (TaT1 and carcinoma in situ) (NMIBC) [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 references/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 consists of an international multidisciplinary group of clinicians, including urologists, oncologists, a pathologist, a radiologist, radiotherapists and patient representatives. Section 5.3 - MIBC and health status, was developed with the assistance of Prof.Dr. S. O’Hanlon, consultant geriatrician, International Society of Geriatric Oncology (SIOG) representative. 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/guidelines/muscle-invasive-and-metastatic-bladder-cancer/panel.
1.3. Available publications
A quick reference document (Pocket Guidelines) is available. This is an abridged version which may require consultation together with the full text version. Several scientific publications are available, the latest dating to 2023 [4]. All documents are accessible through the EAU website: https://uroweb.org/guidelines/muscle-invasive-and-metastatic-bladder-cancer.
1.4. Publication history and summary of changes
1.4.1. Publication history
The EAU Guidelines on Muscle Invasive Bladder Cancer were first published in 2004. Standard procedure for EAU Guidelines includes an annual assessment of newly published literature in the field to guide future updates This 2024 MIBC Guidelines present a limited update of the 2023 publication.
1.4.2. Summary of changes
For the 2024 MIBC Guidelines new and relevant evidence was identified, collated and appraised through a structured assessment of the literature for all sections of the Guidelines. Key changes include:
- new updates to the guidelines and evidence in section 5.2 on the magnetic resonance imaging for local staging of MIBC;
- new text and evidence updates in section 7.2.3 on local therapy (surgery or radiotherpy) in oligometastatic disease;
- new text and evidence updates in section 7.3.4.2 on therapeutic value of lymphadenectomy, and section 7.3.5 on robotic-assisted laparoscopic cystectomy;
- new text updates in section 7.5.2 on external beam radiotherapy;
- new text and evidence updates in section 7.5.4 on trimodality bladder-preserving treatment;
- new text, evidence and guidelines updates in section 7.7 on the management of metastatic disease.