Non-muscle invasive bladder cancer: a summary of current guidelines

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Takeaway
  • 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.

Key findings

  • 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.

Limitations

  • Limited to 4 guidelines only.