Bladder Cancer Management in Brazil's Supplementary Health System: Real-World Practice Patterns

The objective of the present study was to evaluate real-world practices of Brazilian urologists regarding bladder cancer management within the supplementary healthcare system.

A cross-sectional, survey-based study was conducted among Brazilian urologists. A structured questionnaire assessed demographics, practice characteristics, and management strategies for non-muscle-invasive (NMIBC) and muscle-invasive bladder cancer (MIBC). Data were collected during the 2025 Brazilian Congress of Urology and via electronic distribution. Descriptive statistics were used, and exploratory comparisons were performed.

A total of 914 urologists from 25 federative units (24 states and the federal district) participated in the study. Cystoscopy was nearly universal (93.8%), but access to enhanced imaging (17.9%) and office-based flexible cystoscopy (19.3%) was limited. In NMIBC, most urologists maintained patient care (82.9%), but management was heterogeneous. Immediate postoperative intravesical chemotherapy was rarely used. Bacillus Calmette-Guérin (BCG) was prescribed in most cases of recently treated NMIBC by 39.3% of respondents, while 54.2% referred patients for administration. Although 74.5% reported access to it, only 14.3% had availability for all patients. Preference flow analysis showed BCG as the main first-line therapy (65.4%), intravesical chemotherapy as second-line (51.2%), and pembrolizumab (31.3%) and radical cystectomy (30.2%) as third-line options. Radical cystectomy is annually performed by 65.1% of respondents; however, most reported low annual volumes, with 95% performing fewer than ten cases per year.

Bladder cancer management in the Brazilian supplementary healthcare system is heterogeneous, with important gaps in access, technology availability, and adherence to recommended practices. Despite limitations inherited to survey-based research, including potential selection bias, reliance on self-reported data, and possible overlap between public and private practice settings, these findings highlight opportunities for educational initiatives and system-level improvements.