PET in bladder cancer imaging

[Urothelial carcinoma of the upper and lower urinary tract-which risk factors make early detection worthwhile?]

Urothelial carcinoma is one of the most common malignancies both in Germany and worldwide. Due to the frequent occurrence of late-onset or nonspecific symptoms, carcinomas are often diagnosed at advanced stages. Structured early detection programs have the potential to detect urothelial carcinoma in earlier stages and to improve survival rates. Various risk factors are associated with urothelial carcinoma, most notably tobacco abuse and occupational exposure, as well as genetic disorders such as Lynch syndrome in upper urinary tract carcinoma. In clinical practice, diagnostic tools include general examinations and ultrasound imaging of the urinary tract, with microhematuria and urine cytology playing key roles. For screening purposes noninvasive urine markers have demonstrated limited evidence. Despite the lack of optimal diagnostic markers for systematic early detection in high-risk populations, it is essential to ensure that every patient presenting with hematuria undergoes appropriate and risk-adapted diagnostics.

Bladder sparing options for muscle-invasive bladder cancer

PURPOSE OF REVIEW

This review critically evaluates the current state of bladder-sparing options in muscle-invasive bladder cancer (MIBC) and provides an overview of future directions in the field.

RECENT FINDINGS

Bladder-sparing treatments have emerged as viable alternatives to radical cystectomy (RC) for selected patients with MIBC, especially in those who are unfit for RC or elect bladder preservation. Numerous studies have assessed the efficacy of trimodal therapy (TMT), with outcomes comparable to RC in a subgroup of well selected patients. Combining immunotherapy with conventional treatments in bladder-sparing approaches can yield promising outcomes. Current research is making significant progress in optimizing treatment protocols by exploring new combinations of systemic therapy agents, innovative drug delivery methods, and biomarker-based approaches. Furthermore, clinical markers of response are being tested to ensure adequate response assessment.

SUMMARY

Bladder preservation promise to offer a viable alternative to RC for selected patients with MIBC with the potential to improve patient quality of life. Careful patient selection and ongoing research are essential to optimize patient selection, response assessment, and salvage strategies. As evidence continues to evolve, the role of bladder preservation in MIBC is likely to expand, providing patients with more treatment options tailored to their needs and preferences.

Perioperative platform for muscle-invasive bladder cancer trials: designs and endpoints

PURPOSE OF REVIEW

This review explores the design and endpoints of perioperative platforms in clinical trials for muscle-invasive bladder cancer (MIBC).

RECENT FINDINGS

The choice of clinical trial design in perioperative platforms for MIBC must align with specific research objectives to ensure robust and meaningful outcomes. Novel designs in perioperative platforms for MIBC integrate bladder-sparing approaches. Primary endpoints such as pathological complete response and disease-free survival are highlighted for their role in expediting trial results in perioperative setting. Incorporating patient-reported outcomes is important to inform healthcare decision makers about the outcomes most meaningful to patients. Given the growing body of evidence, potential biomarkers, predictive and prognostic tools should be considered and implemented when designing trials in perioperative platforms for MIBC.

SUMMARY

Effective perioperative platforms for MIBC trials are critical in enhancing patient outcomes. The careful selection and standardization of study designs and endpoints in the perioperative platform are essential for the successful implementation of new therapies and the advancement of personalized treatment approaches in MIBC.

Upper Tract Urothelial Carcinoma: A Narrative Review of Current Surveillance Strategies for Non-Metastatic Disease

Non-metastatic upper urinary tract carcinoma (UTUC) is a comparatively rare condition, typically managed with either kidney-sparing surgery (KSS) or radical nephroureterectomy (RNU). Irrespective of the chosen therapeutic modality, patients with UTUC remain at risk of recurrence in the bladder; in patients treated with KSS, the risk of recurrence is high in the remnant ipsilateral upper tract system but there is a low but existent risk in the contralateral system as well as in the chest and in the abdomen/pelvis. For patients treated with RNU for high-risk UTUC, the risk of recurrence in the chest, abdomen, and pelvis, as well as the contralateral UT, depends on the tumor stage, grade, and nodal status. Hence, implementing a risk-stratified, location-specific follow-up is indicated to ensure timely detection of cancer recurrence. However, there are no data on the type and frequency/schedule of follow-up or on the impact of the recurrence type and site on outcomes; indeed, it is not well known whether imaging-detected asymptomatic recurrences confer a better outcome than recurrences detected due to symptoms/signs. Novel imaging techniques and more precise risk stratification methods based on time-dependent probabilistic events hold significant promise for making a cost-efficient individualized, patient-centered, outcomes-oriented follow-up strategy possible. We show and discuss the follow-up protocols of the major urologic societies.