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Practice Guideline
. 2017 Sep;198(3):552-559.
doi: 10.1016/j.juro.2017.04.086. Epub 2017 Apr 26.

Treatment of Non-Metastatic Muscle-Invasive Bladder Cancer: AUA/ASCO/ASTRO/SUO Guideline

Sam S Chang  1 , Bernard H Bochner  1 , Roger Chou  1 , Robert Dreicer  1 , Ashish M Kamat  1 , Seth P Lerner  1 , Yair Lotan  1 , Joshua J Meeks  1 , Jeff M Michalski  1 , Todd M Morgan  1 , Diane Z Quale  1 , Jonathan E Rosenberg  1 , Anthony L Zietman  1 , Jeffrey M Holzbeierlein  1
Affiliations
Practice Guideline

Treatment of Non-Metastatic Muscle-Invasive Bladder Cancer: AUA/ASCO/ASTRO/SUO Guideline

Sam S Chang et al. J Urol. 2017 Sep.

Erratum in

  • Erratum.
    [No authors listed] [No authors listed] J Urol. 2017 Nov;198(5):1175. doi: 10.1016/j.juro.2017.09.002. Epub 2017 Sep 12. J Urol. 2017. PMID: 28916242 No abstract available.

Abstract

Purpose: This multidisciplinary, evidence-based guideline for clinically non-metastatic muscle-invasive bladder cancer focuses on the evaluation, treatment and surveillance of muscle-invasive bladder cancer guided toward curative intent.

Materials and methods: A systematic review utilizing research from the Agency for Healthcare Research and Quality as well as additional supplementation by the authors and consultant methodologists was used to develop the guideline. Evidence-based statements were based on body of evidence strengths Grade A, B or C and were designated as Strong, Moderate and Conditional Recommendations with additional statements presented in the form of Clinical Principles or Expert Opinions.

Results: For the first time for any type of malignancy, the American Urological Association, American Society of Clinical Oncology, American Society for Radiation Oncology and Society of Urologic Oncology have formulated an evidence-based guideline based on a risk-stratified clinical framework for the management of muscle-invasive urothelial bladder cancer. This document is designed to be used in conjunction with the associated treatment algorithm.

Conclusions: The intensity and scope of care for muscle-invasive bladder cancer should focus on the patient, disease and treatment response characteristics. This guideline attempts to improve a clinician's ability to evaluate and treat each patient, but higher quality evidence in future trials will be essential to improve level of care for these patients.

Keywords: cystectomy; drug therapy; radiotherapy; urinary bladder neoplasms.

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Conflict of interest statement

Disclaimer: This document was written by the Muscle Invasive Bladder Cancer Guideline Panel of the American Urological Association Education and Research, Inc., which was created in 2015. The Practice Guidelines Committee (PGC) of the AUA selected the committee chair. Panel members were selected by the chair. Membership of the Panel included specialists in urology/medical oncology/radiation oncology with specific expertise on this disorder. The mission of the Panel was to develop recommendations that are analysis-based or consensus-based, depending on Panel processes and available data, for optimal clinical practices in the treatment of muscle-invasive bladder cancer.

While these guidelines do not necessarily establish the standard of care, AUA seeks to recommend and to encourage compliance by practitioners with current best practices related to the condition being treated. As medical knowledge expands and technology advances, the guidelines will change. Today these evidence-based guidelines statements represent not absolute mandates but provisional proposals for treatment under the specific conditions described in each document. For all these reasons, the guidelines do not pre-empt physician judgment in individual cases.

Treating physicians must take into account variations in resources, and patient tolerances, needs, and preferences. Conformance with any clinical guideline does not guarantee a successful outcome. The guideline text may include information or recommendations about certain drug uses (‘off label‘) that are not approved by the Food and Drug Administration (FDA), or about medications or substances not subject to the FDA approval process. AUA urges strict compliance with all government regulations and protocols for prescription and use of these substances. The physician is encouraged to carefully follow all available prescribing information about indications, contraindications, precautions and warnings. These guidelines and best practice statements are not in-tended to provide legal advice about use and misuse of these substances.

Although guidelines are intended to encourage best practices and potentially encompass available technologies with sufficient data as of close of the literature review, they are necessarily time-limited. Guidelines cannot include evaluation of all data on emerging technologies or management, including those that are FDA-approved, which may immediately come to represent accepted clinical practices.

For this reason, the AUA does not regard technologies or management which are too new to be addressed by this guideline as necessarily experimental or investigational.

Figures

Figure 1
Figure 1. Non-Metastatic Muscle-Invasive Bladder Cancer: Treatment Algorithm
CBC=complete blood count; CMP=comprehensive metabolic panel; CXR=chest X-ray; p=pathologic stage; TURBT=trans-urethral resection of bladder tumor; XRT=external beam radiation therapy; Yp=pathologic stage after neoadjuvant chemotherapy
See this image and copyright information in PMC

References

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