New AUA guidelines for the treatment of non-muscle invasive bladder cancer represent the first time U.S. guidelines have included recommendations for diagnostic evaluation, risk stratification, treatment protocols and surveillance plans.
“The previous guidelines were based on certain general patient case types,’” said Sam S. Chang, MD, MBA, the Patricia and Rodes Hart Professor of Urologic Surgery at the Vanderbilt University Medical Center. “Nothing was said about how you evaluate, how you stratify or how you follow-up.”
Dr. Chang will present the new guidelines at 7:30 a.m. Tuesday at the beginning of the Plenary I program in Hall A in the San Diego Convention Center.
“These updated guidelines give some suggestions for the surgeon in the risk assessment, management and surveillance of the heterogeneous, non-muscle invasive bladder cancer group,” he said. “These guidelines, by necessity, cannot be specific for each and every patient, but at least they provide a treatment rationale and paradigm.”
The new guidelines address the proper use of urinary markers in the evaluation and follow-up of patients with bladder cancer, and the recommended use of intravesical immunotherapy and chemotherapy in different clinical situations. Another clinical point of emphasis is the importance of timely cystectomy in certain patients as opposed to continued, unsuccessful intravesical therapy. Enhanced cystoscopy technology is also addressed.
The new guidelines integrate an algorithm format that uses flow charts to augment the written descriptions. The most recent guidelines for non-muscle invasive bladder cancer were published in 2007.
“There are no revolutionary drugs, so the focus is on better assessing, using the technology, maybe using the urine markers—but they are not great yet—and also identifying features and using them to try and determine, ‘Hey, this patient is actually a higher risk than we think,’ and going from there,” Dr. Chang said.
The guideline committee, which included a patient advocate for the first time, incorporated comments from a stringent review process that invited feedback from more than 100 reviewers.
Dr. Chang said the committee benefited greatly from assistance provided by the U.S. Agency for Healthcare Research and Quality (AHRQ). AHRQ involvement was the result of a competitive funding process where the AUA convinced the agency that non-muscle invasive bladder cancer warranted federal research support.
Bladder cancer remains an important health problem, according to the AHRQ, with no improvement in associated mortality since 1975. The agency also noted economic analyses identifying bladder cancer as the costliest cancer to treat in the U.S. on a per capita basis, factoring in diagnostic testing, management and long-term follow-up.
Dr. Chang said the guideline committee worked with the AHRQ to review literature from the past five years, as well as historically important articles. Representatives from the agency attended committee meetings but did not participate in the formulation of the guidelines.
“Many, many organizations ask for support from the government to do research, and AHRQ chose this question as clinically important,” Dr. Chang said.
Plenary I Preview
Non-muscle Invasive Bladder Cancer
Presenter: Sam S. Chang, MD, MBA
7:30 – 7:40 a.m. Tuesday
Hall A, San Diego Convention Center