French ccAFU guidelines – Update 2018–2020: Bladder cancer

Area of Science:

• Urology
• Oncology

Background:

• Current French guidelines for non-muscle invasive bladder cancer (NMIBC) and muscle-invasive bladder cancer (MIBC) require updating.
• Evidence-based treatment strategies are crucial for improving patient outcomes in bladder cancer management.

Observation:

• Diagnosis of NMIBC relies on deep tumor resection, fluorescence, and second-look procedures. Risk stratification using the EORTC score guides adjuvant therapies like chemotherapy or intravesical BCG.
• MIBC evaluation involves advanced imaging (CT, MRI). Radical cystectomy with lymph node dissection, potentially preceded by neoadjuvant chemotherapy, is standard for non-metastatic MIBC.
• Metastatic MIBC treatment involves platinum-based chemotherapy, with immunotherapy (pembrolizumab) showing survival benefits in second-line treatment.

Findings:

• Updated guidelines incorporate fluorescence diagnosis, risk stratification for NMIBC, and standardized treatment protocols including intravesical BCG and chemotherapy.
• Recommendations for MIBC emphasize multimodal treatment approaches, including neoadjuvant chemotherapy and radical cystectomy with extended lymph node dissection.
• The guidelines address surgical options, urinary diversion, and the integration of ERAS protocols for enhanced recovery after surgery.

Implications:

• Implementation of these updated guidelines is expected to elevate the standard of urological care for both NMIBC and MIBC.
• These guidelines provide a framework for optimizing bladder cancer diagnosis, treatment, and follow-up in France.
• Adoption of these evidence-based recommendations can lead to improved patient outcomes and management of bladder cancer.