European Medical Journal Urology (Apr 2016)
Managing Patients with Non-Muscle Invasive Bladder Cancer: Old Disease, New Ideas
Abstract
Prof Per-Uno Malmström opened this symposium on non-muscle invasive bladder cancer (NMIBC) by describing the medical and economic burden caused by the increasing incidence of bladder cancer and the lack of new therapeutic options available to address the challenges of the management of NMIBC. Prof Marko Babjuk followed with a presentation that demonstrated that risk stratification using European Organisation for Research and Treatment of Cancer (EORTC) and Spanish Urological Club for Oncological Treatment (CUETO) risk scores remains a useful tool for determining the best individual treatment options for patients. The next presentation, given by Dr Carsten Ohlmann, described the use of mitomycin C (MMC) for low and intermediate-risk patients as per the European Association of Urology (EAU) guidelines. However, despite a favourable safety profile, single case reports of severe adverse events following treatment with MMC should not be dismissed. MMC should therefore be given with care, with an emphasis on performing high quality transurethral resection of the bladder (TURB). Prof Bernard Malavaud then presented details of newer diagnostic methods, such as photodynamic diagnosis (PDD) and narrow band imaging (NBI), which offer better optical tumour recognition for the surgeon than the old standard of white light cystoscopy. The uptake of PDD and NBI in the future will facilitate an increase in the quality of TURB. Finally, Prof Ashish Kamat explained that recurrence of bladder cancer after bacillus Calmette–Guérin (BCG) treatment (‘BCG failure’) needs to be more clearly defined and stratified. He stated that optimal recognition of timing with relation to BCG immunotherapy is critical to determine the next steps. For example, in the past, patients with late recurrence who may have benefitted from challenge with BCG may have been overlooked.
