Controversies in NMIBC: Guidelines and Beyond

Posted by Michael S. Cookson, MD, MMHC | Apr 2019

Michael S. Cookson, MD, presented “Controversies in NMIBC: Guidelines and Beyond” during the 3rd Annual International Bladder Cancer Update on January 23, 2019 in Beaver Creek, Colorado.

How to cite: Cookson, Michael S. “Controversies in NMIBC: Guidelines and Beyond” January 23, 2019. Accessed Apr 2024. https://grandroundsinurology.com/controversies-in-nmibc-guidelines-and-beyond/

Controversies in NMIBC: Guidelines and Beyond- Summary:

Michael S. Cookson, MD, MMHC, reviews practice-changing recommendations from recently updated guidelines for non-muscle invasive bladder cancer (NMIBC). He specifically emphasizes the importance of variant histology and risk-stratification in treatment decision-making for NMIBC.

Abstract:

The American Urological Association (AUA), American Society of Clinical Oncology (ASCO), and Radiation Therapy Oncology Group (RTOG) have recently updated their guidelines for NMIBC. This presentation emphasizes some of the practice-changing recommendations included in these guidelines, with the goal of improving patient outcomes. It also stresses the importance of variant histology and risk-stratification in the management of patients with NMIBC.

Recognition of variant histology often requires expert genitourinary pathology review. Recognition has profound implications for not only patient management, such as choosing between bladder conservation and cystectomy, but also prognosis and response to systemic therapies. Additionally, this presentation discusses the use and importance of a complete bladder tumor resection and repeat transurethral resection (TUR) for patients with high-risk NMIBC. The guidelines recommend repeat TUR for all incompletely resected tumors, all T1 tumors, and for variant histology cases under consideration for bladder conservation. Physicians should also consider repeat TUR for high grade Ta tumors.

This presentation also covers the benefits of perioperative, induction, and maintenance intravesical therapies based on patient risk-stratification. The guidelines recommend risk-stratification for all patients with NMIBC, and specifically categorize patients based on a variety of clinicopathologic features that include response to prior therapies. Furthermore, the risk-stratification categories have implications for type and duration of intravesical therapy.

In addition, the presentation will provide instructions for identifying the diagnostic modalities that enhance detection of bladder cancer. These techniques have resulted not only in enhanced detection, but reduction in both the time leading up to and overall tumor recurrence.

About the International Bladder Cancer Update

The International Bladder Cancer Update (IBCU) is an annual one-day CME conference focused on bladder cancer treatment updates. IBCU takes place during its sister conference, the International Prostate Cancer Update (IPCU). The conference’s faculty consists of international experts, and the event caters to urologists, urologic oncologists, and other healthcare professionals. In addition to didactic lectures, IBCU features interactive discussions, a panel roundtable, debates, and case presentations. Dr. Cookson presented this lecture during the 3rd IBCU in 2019. Please visit this page in order to learn more about future IBCU meetings.

About The Author

Michael S. Cookson, MD, MMHC

Michael S. Cookson, MD, MMHC, is Professor and Chairman of the Department of Urology and holds the Donald D. Albers Endowed Chair in Urology at the University of Oklahoma Health Sciences Center in Oklahoma City. He has authored some 240 peer-reviewed journal publications as well as more than 30 chapters of various textbooks, and he is nationally recognized for his outstanding contributions to urologic oncology. Dr. Cookson completed his Urology Residency at the University of Texas, San Antonio, and completed his Urologic Oncology Fellowship at Memorial Sloan-Kettering Cancer Center in New York. From 1998 to 2013, he served as the Vice Chairman of Urologic Surgery and Director of the Urologic Oncology Fellowship Program at Vanderbilt University. Dr. Cookson has devoted much of his academic career to the management of patients with urologic cancers, with a strong emphasis on clinical guidelines, education, and evidenced-based medicine. He was a member of the AUA/ABU Examination Committee for 10 years, serving as Oncology Consultant and Pathology Editor. He also serves on the ABU Oral Examination Committee. He is a Co-Founder of the Oncology Knowledge Assessment Test (OKAT), an SUO-mandated examination. He also served as Chair for the OKAT for 5 years. In 2011, he received the President’s Distinguished Service Award from the SUO for educational contributions. He received the 2018 AUA Presidential Citation for Outstanding Service for his role in the development of the OKAT and as Chair of the Castration-Resistant Prostate Cancer Guidelines Committee at the AUA 2018 Annual Meeting. Dr. Cookson has previously served as a member of the AUA Guidelines on Localized Prostate Cancer Committee. Dr. Cookson is currently serving out the 2019-2020 term as the SUO President.

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