Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Jan-Feb;42(1):22-8.
doi: 10.1590/S1677-5538.IBJU.2015.0122.

Are we following the guidelines on non-muscle invasive bladder cancer?

Leonardo Oliveira Reis  1 , Juliano Cesar Moro  2 , Luis Fernando Bastos Ribeiro  2 , Brunno Raphael Iamashita Voris  2 , Marcos Vinicius Sadi  3
Affiliations

Are we following the guidelines on non-muscle invasive bladder cancer?

Leonardo Oliveira Reis et al. Int Braz J Urol. 2016 Jan-Feb.

Abstract

Objective: To evaluate the clinical practice of non-muscle invasive bladder cancer (NMIBC) treatment in Brazil in relation to international guidelines: Sociedade Brasileira de Urologia (SBU), European Association of Urology (EAU) and American Urological Association (AUA).

Methods: Cross-sectional study using questionnaires about urological practice on treatment of NMIBC during the 32nd Brazilian Congress of Urology. A total of 650 question forms were answered.

Results: There were 73% of complete answers (total of 476 question forms). In total, 246 urologists (51.68%) lived in the southeast region and 310 (65.13%) treat 1 to 3 cases of NMIBC per month. Low risk cancer: Only 35 urologists (7.5%) apply the single intravesical dose of immediate chemotherapy with Mitomicin C recommended by the above guidelines. Adjuvant therapy with BCG 2 to 4 weeks after TUR is used by 167 participants (35.1%) and 271 urologists (56.9%) use only TUR. High risk tumors: 397 urologists (83.4%) use adjuvant therapy, 375 (78.8%) use BCG 2 to 4 weeks after TUR, of which 306 (64.3%) referred the use for at least one year. Intravesical chemotherapy with Mitomicin C (a controversial recommendation) was used by 22 urologists (4.6%). BCG dose raised a lot of discrepancies. Induction doses of 40, 80 and 120mg were referred by 105 (22%), 193 (40.4%) and 54 (11.3%) respectively. Maintenance doses of 40, 80 and 120mg were referred by 190 (48.7%), 144 (37.0%) and 32 (8.2%) urologists, respectively. Schemes of administration were also varied and the one cited by SWOG protocol was the most used: 142 (29.8%).

Conclusions: SBU, EAU and AUA guidelines are partially respected by Brazilian urologists, particularly in low risk tumors. In high risk tumors, concordance rates are comparable to international data. Further studies are necessary to fully understand the reasons of such disagreement.

PubMed Disclaimer

Figures

Figure 1
Figure 1. Treatment of low risk tumors.
See this image and copyright information in PMC

References

    1. Burger M, Catto JW, Dalbagni G, Grossman HB, Herr H, Karakiewicz P, et al. Epidemiology and risk factors of urothelial bladder cancer. Eur Urol. 2013;63:234–241. - PubMed
    1. Bjerregaard BK, Raaschou-Nielsen O, Sørensen M, Frederiksen K, Christensen J, Tjønneland A, et al. Tobacco smoke and bladder cancer--in the European Prospective Investigation into Cancer and Nutrition. Int J Cancer. 2006;119:2412–2416. - PubMed
    1. [Acessed in july, 07 2014];Instituto Nacional do Câncer (INCA) http://www2.inca.gov.br/wps/wcm/connect/tiposdecancer/site/home/bexiga.
    1. Sociedade Brasileira de Urologia e Sociedade Brasileira de Patologia Bladder cancer-staging and treatment I. Rev Assoc Med Bras. 2008;54:196–198. - PubMed
    1. Brausi M, Witjes JA, Lamm D, Persad R, Palou J, Colombel M, et al. A review of current guidelines and best practice recommendations for the management of nonmuscle invasive bladder cancer by the International Bladder Cancer Group. J Urol. 2011;186:2158–2167. - PubMed