Treatment strategies debated at annual Bladder Cancer Forum

What is the optimal treatment strategy for patients with nonmuscle-invasive bladder cancer (NMIBC) at intermediate risk (IR)? When is active surveillance appropriate? What type of cystoscopy is necessary to adequately diagnose bladder cancer? Those are among the topics debated in Sunday’s second annual AUA/International Bladder Cancer Group (IBCG) forum, which involved patient cases and audience participation.

Paolo Gontero, MD, professor of urology and chair of the department of urology at Molinette Hospital in Torino, Italy, kicked off the debate by presenting evidence that favored treating a patient with IR NMIBC versus active surveillance.

“According to AUA guidelines, intermediate risk is primarily low-grade disease, but there’s a subgroup of patients who should be treated,” Dr. Gontero said. “Patients with intermediate-risk, nonmuscle-invasive bladder cancer are not always indolent.”

Gary Steinberg, MD, director of the Bladder Cancer Program at NYU Langone Health, followed with an equally compelling case for the surveillance of patients with IR NMIBC.

“Intermediate-risk, nonmuscle-invasive bladder cancer is heterogeneously associated with high rates of recurrence and a low rate of progression and cancer-specific mortality,” Dr. Steinberg said. “Watchful waiting surveillance with fulguration in the clinic with local anesthesia is preferential.”            

Another hot topic: Do skilled urologists really need photodynamic diagnosis (PDD) or blue light cystoscopy? Should it be used in conjunction with white light cystoscopy? Michael Cookson, MD, professor and chairman of urology at the University of Oklahoma College of Medicine, provided strong evidence that skilled urologists don’t need PDD/blue light cystoscopy, which is underutilized in the U.S.

“There’s no impact of PDD on progression or overall survival, and the cost of the blue light cystoscopy equipment is substantial,” Dr. Cookson said.            

Timothy J. Bivalacqua, MD, PhD, director of urologic oncology at Penn Medicine, countered with the argument that skilled urologists do need PDD/blue light cystoscopy by presenting evidence supporting its use. Plus, patients like it. “Blue light cystoscopy improves health-related quality of life in NMIBC patients,” Dr. Bivalacqua said.

Ultimately, the audience sided with Dr. Bivalacqua. When asked if they would incorporate blue light cystoscopy into their practice if they had access to it, most audience members raised their hands.

The IBCG presents recommendations to guidelines committees, including the AUA.

“We’re bladder cancer addicts,” said Ashish Kamat, MD, the forum moderator. Dr. Kamat is endowed professor of urologic oncology (surgery) and cancer research at the University of Texas MD Anderson Cancer Center, and president of the IBCG. “The IBCG is on a mission to improve bladder cancer outcomes through evidence-based treatment. Membership includes anybody interested in bladder cancer,” Dr. Kamat said.

For more information, visit the IBCG.