Non-Muscle Invasive Bladder Cancer: Guidelines-Based Approach

Posted by Raj S. Pruthi, MD, MHA, FACS | May 2022

Raj S. Pruthi, MD, MHA, FACS, presented “Non-Muscle Invasive Bladder Cancer: Guidelines-Based Approach” during the 41st Annual Ralph E. Hopkins Urology Seminar on February 5, 2022, in Jackson Hole, Wyoming.

How to cite: Pruthi, Raj S. “Non-Muscle Invasive Bladder Cancer: Guidelines-Based Approach.” February 5, 2022. Accessed Apr 2024. https://grandroundsinurology.com/non-muscle-invasive-bladder-cancer-guidelines-based-approach/

Non-Muscle Invasive Bladder Cancer: Guidelines-Based Approach

Raj S. Pruthi, MD, MHA, FACS, Professor in the Department of Urology at the University of California, San Francisco, reviews the American Urological Association (AUA)-Society of Urologic Oncology (SUO) guidelines on diagnosing and treating non-muscle invasive bladder cancer (NMIBC). He begins with some statistics, relating that in 2017, there were approximately 79,000 new cases of bladder cancer, 16,800 deaths, and greater than 500,000 survivors. Dr. Pruthi observes that bladder cancer is a disease of older individuals, and he predicts that the population of bladder cancer patients will increase as the population ages. He then highlights key facts about NMIBC, explaining that most patients recur, some progress, and the ability to predict recurrence and progression is based on patient-specific disease characteristics. Dr. Pruthi introduces the 2016 AUA/SUO guidelines, noting that the panel featured a patient advocate. He goes over the guidelines point by point, starting with diagnosis. Dr. Pruthi underscores the importance of performing a complete visual transurethral resection of bladder tumor (TURBT) at initial diagnosis, explaining that incomplete TURBT is a contributing factor to early recurrences. He notes that risk calculators for NMIBC are limited by lack of applicability to current populations, and also that no study has evaluated the effectiveness of urinary biomarkers to decrease mortality or improve outcomes compared with standard diagnostic methods. When discussing guidelines around treatment, Dr. Pruthi emphasizes the importance of re-resecting T1 disease since understaging occurs in about 30% of cases and patients with residual T1 (after presumed complete resection) have up to an 80% chance of progression. He also discusses guidelines around BCG administration and BCG relapse. Dr. Pruthi then looks at cystectomy, arguing that waiting until progression to muscle invasion may prove fatal. He concludes by discussing guidelines around follow up.

About The 41st Annual Ralph E. Hopkins Urology Seminar:

The Ralph E. Hopkins Urology Seminar is a multi-day meeting focused on training urologists in the latest in assessing, diagnosing, and treating urologic conditions in the clinical setting. Updates are provided on urologic cancers, stone disease, urologic reconstruction, female urology, infertility, emerging surgical techniques, and general urology. Dr. Pruthi presented this lecture during the 41st iteration of the meeting on February 5th, 2022 in Jackson Hole, Wyoming.

For further educational activities from this conference, visit our collection page.

About The Author

Raj S. Pruthi, MD, MHA, FACS

Dr. Pruthi is a Professor in the Department of Urology at the University of California, San Francisco. He previously served as chair of the Department of Urology at the University of North Carolina at Chapel Hill, where he was on faculty for nineteen years. Serving first as its Chief and then as its inaugural chair, he took the UNC Department of Urology from an unranked program to one of the best in the nation. Dr. Pruthi was a member of the ABU/AUA Examination Committee and serves as an examiner for the Certifying Exam for the ABU. He is also on the Executive Committee for the Society of Academic Urology, as well as the Chair of the Advisory Council for Urology of the American College of Surgeons. Dr. Pruthi helped to develop the American Urological Association’s Guidelines on the Management of Non-muscle Invasive Bladder Cancer. He also served on the Bladder Cancer Guidelines Committee of the International Consultation on Urological Diseases. He is an elected member of the Urologic Research Society, the Society of Pelvic surgeons, the American Association of Genitourinary Surgeons, and the Clinical Society of Genitourinary Surgeons. Dr. Pruthi is a graduate of Stanford University, where he double majored in economics and in biology and became interested in health economics. He received his MD from Duke University School of Medicine. Following medical school, he completed his residency and post-graduate training at Stanford University. Most recently, he completed the executive MHA program at UNC. Dr. Pruthi’s area of clinical expertise is urologic oncology, including prostate and bladder cancer. He is committed to a multi-disciplinary, holistic, and patient-centric approach to care. Dr. Pruthi is a recognized expert in minimally-invasive, robotic surgery for prostate and bladder cancer. He incorporates nerve-sparing techniques to improve recovery and long-term quality of life. He is committed to compassionate, comprehensive, innovative, and patient-centered care that balances long-term survivorship with a high-level of functioning and an optimal quality of life. Dr. Pruthi’s research is focused on surgical innovation, care pathways, and quality of care. Most recently, this primary research has addressed topics related to health economics, including characterizing the urologic workforce, understanding compensation, productivity, and burnout. Dr. Pruthi has been tackling health economic issues to better understand the drivers of faculty productivity, compensation, and burnout. He has explored urologic workforce, projections, gender disparity issues, factors impacting career earnings, predictors of dissatisfaction and burnout, and understanding the impact of workflow initiatives, including the implementation of scribes. His work in these areas has been recognized nationally and has had an impact on the understanding of the practice of urology.

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