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Risk-adapted therapy at the higher risk end of NMIBC – How to make the right choice between BCG and early radical cystectomy

Patients with high-risk, non-muscle-invasive bladder cancer (NMIBC) and urologists alike face the dilemma between the imminent risk of progression and the natural desire for bladder preservation. The 2021 Update of the European Association of Urology (EAU) guidelines for NMIBC provides an improved decision base for informed choices and introduces a ‘very high risk’ group.

Patients with high-risk, non-muscle-invasive bladder cancer (NMIBC) and urologists alike face the dilemma between the imminent risk of progression and the natural desire for bladder preservation. The 2021 Update of the European Association of Urology (EAU) guidelines for NMIBC provides an improved decision base for informed choices and introduces a ‘very high risk’ group. In this webinar, consultant urological surgeon Hugh Mostafid from the UK discussed the new EAU risk groups and how they were developed, the use of prognostic factors in the risk assessment of NMIBC patients, and considerations for selecting the appropriate treatment for these patients. He also reviewed and challenged the dogma around radical cystectomy versus Bacillus Calmette-Guérin (BCG) for high risk NMIBC.

Mostafid presented two illustrative patient case studies: one, a high risk NMIBC patient, and the other, a very high risk NMIBC patient. He used these cases to describe the management of patients in these different risk groups. While discussing treatment options, management, patient outcomes and quality of life of patients with high or very high risk NMIBC, Mostafid considered questions such as: Is there really a trade-off between quality of life and oncological outcome? How is the patient’s global quality of life affected by treatment, age, and fitness? How does the quality of transurethral resection (TUR) and the recommendation for repeat TUR contribute to improved treatment selection and outcomes? How important is it to assign patients to the correct risk group in terms of selecting treatment?

This content is funded by Medac.