- Despite some variations, significant consensus exists in guidelines for non-muscle invasive bladder cancer (NMIBC).
Why this matters
- Confusion about recommendations could play a role in the reportedly low guideline-adherence.
- 4 most commonly used guidelines agree that all visible papillary tumors should be resected.
- European Association of Urology (EAU) offers specifics about transurethral resection (TUR) technique.
- American Urological Association (AUA)/Society of Urologic Oncology (SUO), and National Comprehensive Cancer Network (NCCN) do not require sampling of underlying detrusor muscle at initial TUR.
- All recommend re-TUR for similar indications, optimally within 1-6 wk.
- Upper tract imaging recommended for all patients with confirmed NMIBC by AUA and NCCN, in select cases by EAU, and only in new/recurrent high-risk cases by National Institute for Health and Care Excellence (NICE).
- All consider variant histologies to be high-risk.
- NICE recommends discharge from routine urologic follow-up for low-risk patients free from recurrence at 12 mo.
- All recommend immediate instillation of chemotherapy after TUR in specific settings, but lack clearly defined pathologic criteria.
- Early radical cystectomy is recommended for variant histologies and high-risk tumors based on presence of carcinoma in situ, anatomical involvement, multifocality, and in whom intravesical chemotherapy fails.
- Limited to 4 guidelines only.