Ashish M. Kamat, MD, MBBS, FACS, on why pathology accuracy drives every MIBC treatment decision

In this video, recorded at the 41st Annual Congress of the European Association of Urology in London, the United Kingdom, Ashish M. Kamat, MD, MBBS, FACS, an endowed professor of Urologic Oncology (Surgery) and Cancer Research, and the director of the Bladder Cancer Support Program at University of Texas MD Anderson Cancer Center in Houston,describes the process and key outputs of the International Bladder Cancer Group (IBCG) consensus recommendations on muscle-invasive bladder cancer (MIBC), developed through a modified Delphi process at a live meeting in August 2024 requiring 75% agreement for inclusion.¹

On the consensus process, Kamat emphasizes that the IBCG convenes bladder cancer experts annually to address difficult clinical questions, with patient advocates present throughout deliberations. Regulatory agencies also submit questions in advance. The result is that every published recommendation reflects full agreement among all participants—experts and patient advocates alike. The sharpest disagreements centered on optimal local consolidation: specifically, the longstanding debate between radical cystectomy and radiotherapy-based trimodal therapy. Kamat frames this tension not as institutional rivalry but as a genuine effort to do right by patients in the absence of randomized comparative data, and argues that the manuscript's strongest message is the case for coordinated multidisciplinary care.

On actionable guidance for community practitioners, Kamat's most emphatic recommendation is early pathology review. The diagnosis of MIBC carries enormous downstream consequences—treatment sequencing, surgical planning, systemic therapy—all of which hinge on accurate pathologic characterization. Community urologists should not hesitate to send specimens to referral laboratories, particularly for nuanced determinations such as depth of invasion, variant histology, and lymphovascular invasion, which even expert pathologists may assess differently. He reassures community practitioners that most have qualified urologists and medical oncologists capable of managing these patients, but encourages referral to academic centers when needed, with the expectation that patients can return to their local providers after evaluation.

The IBCG recommendations also endorse time-to-event endpoints for perioperative therapy trials and bladder-intact event-free survival for bladder preservation trials, with an emphasis on patient-reported quality-of-life outcomes.

REFERENCE

1. Gupta S, Li R, Hensley PJ, et al. Optimal management of muscle-invasive bladder cancer: Recommendations from the International Bladder Cancer Group. Eur Urol. 2026 Feb 21:S0302-2838(26)00059-X. doi:10.1016/j.eururo.2026.01.029