AUA releases new guidelines on non-muscle invasive blad...( LINTHICUM MD. The AUA is pleased to ...),Health

LINTHICUM, MD. The AUA is pleased to announce their new Guideline on the Management of Nonmuscle Invasive Bladder Cancer. Each year, more than 60,000 people are diagnosed with bladder cancer, which has been linked to a number of risk factors, including cigarette smoking and exposure to hazardous chemicals. The AUA originally published its guideline in 1999 and the report issued today is an update to that document.

The Guideline focuses on current treatment impacts on outcomes of interest to the patient, such as efficacy outcomes and occurrence of complications and side effects in treated patients. Unfortunately, new evidence on treatment modalities is scant and advances in treatment and physician education regarding treatment are limited.

The Guideline reviews a number of current treatments, including transurethral resection of bladder tumors (TURBT) and the use of chemotherapeutic agents (such as mitomycin C) and immunotherapeutic agents (such as bacillus Calmette-Guerin) in conjunction with TURBT. The panel also reviewed the efficacy of chemotherapy vs. immunotherapy in treating these non-invasive tumors, and the use of these agents in single induction courses compared to use as maintenance therapies.

The Guideline comes to the following conclusions based on current literature:

• Accurate clinical staging upon which to base treatment decisions is critically important. The panel recommends performing a repeat TURBT prior to intravesical therapy in situations where there is high grade T1 disease without muscularis propria in the specimen and in select cases even when there is muscle present.

• A single, post-operative instillation of a chemotherapeutic agent may decrease recurrence risk in patients with superficial disease who have undergone uncomplicated resection of the tumor(s).

• There is no clear superiority of immunotherapy over chemotherapy for low risk disease. Induction
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