Perspectives in Urology Point Counterpoint 2018

Muscle Invasive Bladder Cancer: 2018 Guidelines

Michael S. Cookson, MD, MMHC, outlines the purpose, methodology, and background for recently released guidelines for treating muscle invasive bladder cancer, including cisplatin-based chemotherapy. He highlights recommendation statements regarding patient counseling, neoadjuvant/adjuvant chemotherapy, radical cystectomy, pelvic lymphadenectomies, and more.

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Timing and Optimization of Radium 223 in CRPC

Phillip J. Koo, MD, briefly reviews several clinical trials examining the use of radium 223, focusing on its use in combination with second generation AR inhibitors. He also reviews the data from the ERA 223 trial that was recently reported at ESMO 2018 and discuss lessons learned, including the optimal use of radium 223 in patients with endocrine resistant prostate cancer.

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BCG Maintenance Should Be Less Intense

Michael S. Cookson, MD, MMHC, suggests that the primary evidence does not provide convincing evidence in favor of 3 years of bacillus Calmette-Guérin (BCG) maintenance for non-muscle-invasive bladder cancer (NMIBC). He also notes that long-term BCG often leads to toxicities, contributing to low patient compliance.

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Summarizing the RADAR Guidelines

E. David Crawford, MD, reviews the findings and recommendations of the Radiographic Assessments for Detection of Advanced Recurrence (RADAR) I and II working groups. Phillip J. Koo, MD, then discusses the rationale for RADAR III and the expansion in recommendations from the first two iterations, focusing on updates regarding next generation imaging.

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Navigating the M0 Space

E. David Crawford, MD, reviews the historical developments in androgen deprivation therapy (ADT) for prostate cancer and the emergence of the non-metastatic castration-resistant, or M0, prostate cancer. He then describes future directions for treatment options for these patients with a focus on androgen pathway inhibitors.

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Checkpoint Inhibitors for NMIBC

Daniel P. Petrylak, MD, provides an overview of immunotherapy treatment options for non-muscle invasive bladder cancer (NMIBC) including BCG, intravesical therapies, and checkpoint inhibitors. He also discusses clinical trials investigating alternative immunotherapy options for NMIBC other than BCG.

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Adjuvant Therapy in High Risk Renal Cell Carcinoma

Alan H. Bryce, MD, surveys data from three phase III trials on adjuvant therapies for high-risk renal cell carcinoma. He discusses the controversies following the conclusions of the completed trials and emphasizes the need for research in further adjuvant therapies beyond those that target the VEGF pathway.

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