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Dr. Murray on the current state of care in upper tract urothelial carcinoma

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“One of the biggest things that this brings us to for an update of upper tract disease is biopsy alone of an upper tract tumor is not good enough anymore--we must risk stratify these patients,” says Katie S. Murray, DO.

In this video, Katie S. Murray, DO, highlights key takeaways from the session, “Update in Management of Upper Tract Urothelial Carcinoma,” which was presented at the 2024 American Urological Association (AUA) Annual Meeting in San Antonio, Texas. Murray is a professor in the department of urology at the NYU Grossman School of Medicine and the chief of urology service at Bellevue Hospital Center in New York, New York.

Video Transcript:

Could you provide an overview of this session?

What's really exciting is that the AUA is coming out with more and more guidelines in combination with other organizations–for example, the Society of Urologic Oncology, or the SUO–and now has guidelines for upper tract urothelial carcinoma since last year's meeting. It's important for us to know those things as urologists, especially in these rarer diseases such as upper tract urothelial carcinoma, because as urologists, they're not in our practices every day, you're not seeing patients like this, but it's familiar enough that everybody is seeing these particular patients. So, having those guidelines to refer back to is extremely important. During my session at the AUA, what I talked about was an update on where the guidelines have brought us in only a year's time of being able to look at those. The guidelines have a lot of guideline statements, and I think people sometimes can get bogged down by those. But if you really break them up–and that's what I was able to do in the talk is break them up into screening, diagnosis, treatment, and then follow-up or surveillance–they're really quite simple to look at. There's a couple of charts that actually show up around guideline statement 10, and then it talks about risk stratifying patients, and then towards the end of the guidelines, it gives you a chart of how you can follow patients long-term after they've had a treatment for upper tract urothelial carcinoma.

What were some of the key takeaways?

One of the biggest things that this brings us to for an update of upper tract disease is biopsy alone of an upper tract tumor is not good enough anymore--we must risk stratify these patients. That's where we really need to start pushing our practices towards. What that allows us to do is to risk stratify patients on their likelihood of progressing to a more invasive [disease], such as T2 upper tract urothelial carcinoma. What it does is it allows us to use things such as biopsy, radiographic appearance, cytology, appearance on ureteroscopy, [and] put all of those things together to risk stratify patients into either low-risk or high-risk, and then subcategorize those within as favorable or unfavorable. Once you do that and you check all those boxes, the treatment plan is lined up for you right there of what your next steps should be for that patient. This is to guide us as physicians, but also, when describing it to patients, having that easy to understand low-risk and high-risk and where that falls and how those risks guide treatment makes it much easier for patients to understand. So, I think my big push is for urologists to really look at those guidelines and start to learn how to use that risk stratification for upper tract urothelial diagnosis and therefore the subsequent treatment thereafter.

I think the other thing is just like so many of the cancers that we treat as urologists, we're getting more and more intertwined with our colleagues in medical oncology, and upper tract is no different. It's important to consider a referral to medical oncology upfront as a collaboration for neoadjuvant therapy and/or subsequent adjuvant therapy after an appropriate treatment. As we continue to do that, obviously, the urologist is still the person who's guiding the patient's care. But it can be really beneficial to have them and to help us do surveillance and continue to follow-up for our patients. I think my take-home is for upper tract urothelial, risk stratify your patients, biopsy alone is no longer good enough, you must take all of the other patient factors into account, and then guide your treatment on that risk stratification, and that may involve a consultation or at least a multidisciplinary conversation with other colleagues, such as our medical oncology colleagues.

This transcription has been edited for clarity.

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