The European Association of Urology (EAU) and the European Society for Medical Oncology (ESMO) have published guidance on controversial topics in bladder cancer management.
Key among the agreed recommendations are the following:
- Immediate radical cystectomy (RC) and lymphadenectomy for T1 high-grade urothelial cancer (UC) with micropapillary histology.
- Identify RNA subtypes before checkpoint inhibitor therapy.
- Chemoradiation for inoperable locally advanced tumours.
- Use image-guided and intensity-modulated radiotherapy (IMRT) combined with radiosensitiser for bladder preservation.
- IMRT or brachytherapy for above standard radical doses to the primary site for bladder preservation is not recommended.
- Include PET-CT in oligometastatic disease (OMD) staging when considering radical treatment.
- Use adjuvant or neoadjuvant systemic therapy with radical treatment of OMD.
- PD-L1 is not useful in selecting patients with platinum-refractory metastatic UC (mUC) for immunotherapy.
- Carboplatin-based chemotherapy remains a viable first-line treatment option in cisplatin-ineligible, PD-L1-positive mUC.
- Consider chemotherapy instead of immunotherapy sequencing for cisplatin-ineligible, immunotherapy-refractory mUC patients.
- Perform CT thorax and abdomen for 5 years to detect relapse in most patients after RC with curative intent.
- After RC with curative intent, follow-up of the urethra with cytology and/or cystoscopy is recommended in selected patients.
- Perform CT thorax and abdomen for 5 years in most patients to detect relapse (outside the bladder) after trimodality treatment with curative intent.