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Guidelines

Non-muscle-invasive Bladder Cancer

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Additional data has been included throughout this document text. In particular in Chapters/Sections:

  • 5.4 Imaging – with the introduction of Vesical Imaging-Reporting and Data System [VI-RADS]).
  • 5.7.3 Surveillance of non-muscle-invasive bladder cancer – inclusion of urine biomarkers in a surveillance strategy of an individual patient.
  • 5.8 Cystoscopy – inclusion of the procedural chance (‘bag squeeze’). The recommendation was amended accordingly.

Recommendations 

Strength rating

In men, use a flexible cystoscope, if available and apply irrigation ‘bag squeeze’ to decrease procedural pain when passing the proximal urethra.

Strong

 

  • 5.10.2.2 Evaluation of resection quality, resulting in a recommendation change.

Recommendations 

Strength rating

Performance of individual steps

Take biopsies from abnormal-looking urothelium. Biopsies from normal-looking mucosa (mapping biopsies from the trigone, bladder dome, right, left, anterior and posterior bladder wall) are recommended if cytology or urinary molecular marker test is positive. If the equipment is available, perform fluorescence-guided (PDD) biopsies.

Strong

 

  • 7.2.1.3.2 Device-assisted intravesical chemotherapy - Microwave-induced hyperthermia effect (RITE)
  • New section 7.3 Chemoablation and neoadjuvant treatment was added.
  • 7.6.3 Treatment of BCG unresponsive tumours, late BCG-relapsing tumours, low-grade (LG) recurrences after BCG treatment and patients with BCG intolerance, two recommendations were amended.

General recommendations 

Strength rating

In patients with high-risk tumours, full-dose intravesical bacillus Calmette-Guérin (BCG) for one to three years (induction plus 3-weekly instillations at 3, 6, 12, 18, 24, 30 and 36 months), is indicated. The additional beneficial effect of the second and third years of maintenance should be weighed against its added costs, side effects and problems connected with BCG shortage. Immediate radical cystectomy (RC) may also be discussed with the patient.

Strong

 

In patients with very high-risk tumours offer immediate RC. Intravesical full-dose BCG instillations for one to three years to those who refuse or are unfit for RC.

Strong

 

  • 7.8 Guidelines for the treatment of TaT1 tumours and carcinoma in situ according to risk stratification

Recommendations 

Strength rating

EAU risk group: High

Offer intravesical full-dose BCG instillations for one to 3 years or discuss immediate radical cystectomy.

Strong

  • Chapter 8 – Additional information on imaging modalities and urinary markers.

8.1 Summary of evidence and guidelines for follow-up of patients after transurethral resection of the bladder for non-muscle-invasive bladder cancer

Recommendation 

Strength rating

In patients initially diagnosed with Ta LG/G1–2 bladder cancer, use ultrasound of the bladder, and/or a urinary marker during surveillance in case cystoscopy is not possible or refused by the patient.

Weak

 

 

 

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