Robotic vs. open cystectomy: How PFS, OS compare
Evaluation of upper tract surveillance for high-grade, nonmuscle-invasive bladder cancer and evidence suggesting that androgen receptor activity may be related to recurrence and treatment of bladder cancer were among the take-home messages in this area from AUA 2017.
Angela B. Smith, MD, MSEvaluation of upper tract surveillance for high-grade, nonmuscle-invasive bladder cancer and evidence suggesting that androgen receptor activity may be related to recurrence and treatment of bladder cancer were among the take-home messages in this area from AUA 2017. The bladder cancer take-homes were presented by Angela B. Smith, MD, MS, of the University of North Carolina, Chapel Hill.
Robotic cystectomy is not inferior to open cystectomy in terms of 2-year progression-free and overall survival. Robotic cystectomy was associated with increased soft tissue margins, however.
Upper tract surveillance may have limited benefits in high-grade, nonmuscle-invasive bladder cancer (NMIBC).
Risk-based surveillance strategies after cystectomy may streamline cost and efficacy.
Several urine biomarkers, including Cxbladder Resolve and CK20 and IGF-2 plus urine cytology, may have utility in risk stratifying patients with low- and high-risk bladder cancer.
Emerging evidence from a number of studies suggest that androgen receptor activity may be related to recurrence and treatment of bladder cancer.
Continue to the next page for more take-home messages.
- Blue-light flexible cystoscopy should be considered for patients in surveillance of bladder cancer recurrence.
- Intravesical gemcitabine is a new standard for suspected low-grade NMIBC.
- VesiGel, a formulation of mitomycin C and a hydrogel, has chemoablative potential as an alternative to transurethral resection of bladder tumor.
- Separate studies found that combining bacillus Calmette-Guérin with vaccines such as PANVAC and intradermal priming may have a role in increasing efficacy of BCG immunotherapy for high-risk NMIBC.
- CG0070 oncolytic adenovirus shows promise for BCG-unresponsive disease but awaits further follow-up.
- NMIBC patients report worsened urinary symptoms and physical health-related quality of life compared to controls.
- Financial toxicity is prevalent in bladder cancer and negatively impacts health-related quality of life.
- There is a need for biomarkers to increase diagnostic value of transurethral resection for variant histology since there is an important role for treatment and surveillance given varied outcomes of neoadjuvant chemotherapy (NAC).
- Pathologic node-positive disease benefits from adjuvant chemotherapy.
- Determining extent of pelvic lymph node dissection may be aided by stage and frozen section analysis.
- DNA repair mechanisms have a future role in NAC selection.
- Basal tumors are high risk but have favorable NAC response, resulting in better survival.
Subscribe to Urology Times to get monthly news from the leading news source for urologists.
Speaking of Urology Podcast: Dr. Ritch and Dr. Katz discuss new bladder cancer management app
December 7th 2021“It's not a replacement for clinical judgment, obviously. But at the end of the day, the idea is that it shows you what your next steps are based on what the American Urological Association and [Society of Urologic Oncology] guidelines are for non-muscle invasive bladder cancer,” Chad R. Ritch, MD, MBA, FACS.
Nadofaragene firadenovec shows durable efficacy in NMIBC
April 8th 2024"In this follow-up analysis of the phase 3 study, we demonstrated a sustained response to Adstiladrin treatment over 3 years, allowing more than half of the patients in the study to remain cystectomy free for at least 36 months,” says Colin P.N. Dinney, MD.
