A Failed Strategy for an Effective Bladder Cancer Drug A Failed Strategy for an Effective Bladder Cancer Drug

When the number of doses of BCG for high-grade non-muscle invasive bladder cancer was cut, outcomes were inferior in a randomized clinical trial.Medscape Medical News
Source: Medscape Urology Headlines - Category: Urology & Nephrology Tags: Hematology-Oncology News Source Type: news

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Source: Current Opinion in Urology - Category: Urology & Nephrology Tags: BLADDER CANCER: Edited by Juan Palou and Óscar Rodríguez Faba Source Type: research
Purpose of review Given the worldwide shortage of Bacillus Calmette–Guérin (BCG), we review the efficacy of alternative BCG application schedules, doses or strains and intravesical chemotherapy in patients with nonmuscle-invasive bladder cancer (NMIBC). Recent findings Modifying BCG schedules by reducing the dose is preferable to reducing the frequency of BCG that increases recurrence rates and should be avoided if possible. Changing the BCG substrain represents a reasonable option, as current evidence does not suggest different oncological outcomes with specific BCG substrains. Mitomycin C (MMC) alone is...
Source: Current Opinion in Urology - Category: Urology & Nephrology Tags: BLADDER CANCER: Edited by Juan Palou and Óscar Rodríguez Faba Source Type: research
Purpose of review To summarize the current knowledge on the role of repeated transurethral resection of the bladder (re-TURBT) at the light of recently published trials that indicate the possibility to safely avoid it in well selected patients. Recent findings Recently published trials tried to predict the histology of re-TURBT with the aim of improving patients’ selection for this procedure. The en bloc resection technique seems to improve the quality of the resection, thereby diminishing and even eliminating the risk of upstaging and the residual disease rate after TURBT. Moreover, the introduction of multipar...
Source: Current Opinion in Urology - Category: Urology & Nephrology Tags: BLADDER CANCER: Edited by Juan Palou and Óscar Rodríguez Faba Source Type: research
Purpose of review Accurate staging of bladder cancer is essential to guide appropriate management. In this review, we discuss the principles, applications and performance of multiparametric MRI (mpMRI) and PET-computer tomography (PET-CT) for local and distant staging of bladder cancer. Recent findings Bladder mpMRI has a high diagnostic performance in local staging of bladder cancer, superior to other imaging modalities. It can accurately differentiate muscle invasive bladder cancer (MIBC) from non-MIBC (NMIBC), as well as ≤T2 from ≥T3 stages. mpMRI can be used to assess pelvic lymph nodes, although its sensiti...
Source: Current Opinion in Urology - Category: Urology & Nephrology Tags: BLADDER CANCER: Edited by Juan Palou and Óscar Rodríguez Faba Source Type: research
Purpose of review Patients with nonmuscle invasive bladder cancer (NMIBC) have a high risk of recurrent tumors, even in spite of contemporary guideline recommended therapy. Follow-up recommendations are also clear (cystoscopy with cytology and upper urinary tract imaging in high-risk patients), but frequency and duration of follow-up are well defined. However, recent developments in follow-up tools might be of interest for clinical practice. Recent findings Enhanced endoscopy improves detection and treatment of recurrences, and it can help in tailoring follow-up. However, it remains an invasive procedure. Most recentl...
Source: Current Opinion in Urology - Category: Urology & Nephrology Tags: BLADDER CANCER: Edited by Juan Palou and Óscar Rodríguez Faba Source Type: research
Purpose of review The standard diagnosis of carcinoma in situ (CIS) of the bladder, based on white light cystoscopy and urine cytology, is limited because CIS can vary from normal-appearing mucosa to a lesion indistinguishable from an inflammatory process. Intravesical instillation of Bacillus Calmette–Guerin (BCG) remains first-line therapy; however, a significant proportion of cases persist or recur after BCG treatment. This review summarizes recent improvements in the detection and treatment of CIS. Recent findings The new optical technologies improve CIS detection, with a potential positive impact on oncolog...
Source: Current Opinion in Urology - Category: Urology & Nephrology Tags: BLADDER CANCER: Edited by Juan Palou and Óscar Rodríguez Faba Source Type: research
Purpose of review Radical cystectomy is the definitive surgical treatment for aggressive bladder cancer. The robotic platform offers a new approach to radical cystectomy, but the benefits are unclear. This review examines the latest evidence, with a particular focus on developments in the last two years. Recent findings Prospective evaluations of open (ORC) and robot-assisted radical cystectomy (RARC) are emerging. The radical cystectomy in patients with bladder cancer trial reported in 2018 and demonstrated oncological noninferiority for both approaches and marginal shorter length of stays with RARC using an extracor...
Source: Current Opinion in Urology - Category: Urology & Nephrology Tags: BLADDER CANCER: Edited by Juan Palou and Óscar Rodríguez Faba Source Type: research
Purpose of review The aim of this review is to provide insight into the current state of lymph node dissection (LND) during radical cystectomy in patients with bladder cancer (BCa). Recent findings The first prospective, multicenter, randomized, phase III trial to assess the therapeutic benefit of extended versus limited LND at the time of radical cystectomy failed to demonstrate relevant improvement with extended LND, but showed that this approach does not increase overall complications. Although contemporary rate of LND during radical cystectomy has increased, it remains suboptimal. Minimally invasive radical cystec...
Source: Current Opinion in Urology - Category: Urology & Nephrology Tags: BLADDER CANCER: Edited by Juan Palou and Óscar Rodríguez Faba Source Type: research
Purpose of review The orthotopic neobladder and ileal conduit are the two most commonly utilized urinary diversions among patients undergoing radical cystectomy. Although orthotopic diversion offers several advantages, only 20% of patients nationally receive this diversion, with decreasing utilization over time. The purpose of this article is to review advantages of each diversion type and considerations in patient selection, review trends in diversion utilization and perioperative and functional outcomes, and examine recent studies evaluating methods of optimizing diversion selection and patient satisfaction and outcome...
Source: Current Opinion in Urology - Category: Urology & Nephrology Tags: BLADDER CANCER: Edited by Juan Palou and Óscar Rodríguez Faba Source Type: research
Purpose of review En bloc resection of bladder tumor (ERBT) is an innovative new surgical technique, the use of which is becoming increasingly widespread. In this review, we analyze the recent literature and explore new developments, which may impact the future role of en bloc bladder surgery. Recent findings ERBT increases the frequency with which detrusor muscle is present in the specimen (to 95%) and offers a significant improvement in the quality of the resection specimen, thereby helping with T1 substaging. Furthermore, the laser treatment reduces the rate of obturator nerve-related bladder perforation. Summary ...
Source: Current Opinion in Urology - Category: Urology & Nephrology Tags: BLADDER CANCER: Edited by Juan Palou and Óscar Rodríguez Faba Source Type: research
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