Bladder Preservation Strategies in Muscle-invasive Bladder Cancer: Recommendations from the International Bladder...

Area of Science:

• Urology
• Oncology
• Cancer Treatment

Background:

• Patient-centered care emphasizes aligning treatment with individual patient values and needs.
• Radical cystectomy (RC) is a standard treatment for muscle-invasive bladder cancer (MIBC), but bladder preservation therapies (BPTs) offer alternatives.
• There is an urgent need for critical assessment and practical recommendations for selecting patients for BPTs in MIBC management.

Purpose of the Study:

• To develop consensus recommendations for bladder preservation therapies (BPTs) in muscle-invasive bladder cancer (MIBC).
• To provide practical guidance for the optimal selection of patients eligible for BPTs.
• To establish evidence-based criteria for considering BPTs as an alternative to radical cystectomy (RC).

Main Methods:

• A global committee of bladder cancer experts was convened.
• A modified Delphi process involving International Bladder Cancer Group (IBCG) members was used for voting on recommendations.
• Recommendations were refined through live meetings and subsequent electronic discussions based on evidence and expert consensus.

Main Results:

• Patients with newly diagnosed MIBC should be evaluated in a multidisciplinary setting for BPT consideration.
• Trimodal therapy (TMT) is the primary alternative to RC, with favorable prognostic factors including unifocal cT2 stage, no hydronephrosis, and no multifocal carcinoma in situ (CIS).
• Other BPTs, such as partial cystectomy (PC), are reserved for select patients ineligible for or declining TMT or RC.

Conclusions:

• The International Bladder Cancer Group (IBCG) has established consensus recommendations for BPTs in MIBC.
• These recommendations offer practical guidance for clinicians in managing MIBC.
• The consensus supports patient-centric decision-making by outlining options for bladder preservation.