title: EAU guidelines on muscle-invasive and metastatic bladder cancer: summary of the 2013 guidelines.
abstract: BACKGROUND
  The European Association of Urology (EAU) guidelines panel on Muscle-invasive and Metastatic bladder cancer (BCa) updates its guidelines yearly. This updated summary provides a synthesis of the 2013 guidelines document, with emphasis on the latest developments.
  
  
  OBJECTIVE
  To provide graded recommendations on the diagnosis and treatment of patients with muscle-invasive BCa (MIBC), linked to a level of evidence.
  
  
  METHODS
  For each section of the guidelines, comprehensive literature searches covering the past 10 yr in several databases were conducted, scanned, reviewed, and discussed both within the panel and with external experts. The final results are reflected in the recommendations provided.
  
  
  RESULTS
  Smoking and work-related carcinogens remain the most important risk factors for BCa. Computed tomography (CT) and magnetic resonance imaging can be used for staging, although CT is preferred for pulmonary evaluation. Open radical cystectomy with an extended lymph node dissection (LND) remains the treatment of choice for treatment failures in non-MIBC and T2-T4aN0M0 BCa. For well-informed, well-selected, and compliant patients, however, multimodality treatment could be offered as an alternative, especially if cystectomy is not an option. Comorbidity, not age, should be used when deciding on radical cystectomy. Patients should be encouraged to actively participate in the decision-making process, and a continent urinary diversion should be offered to all patients unless there are specific contraindications. For fit patients, cisplatinum-based neoadjuvant chemotherapy should always be discussed, since it improves overall survival. For patients with metastatic disease, cisplatin-containing combination chemotherapy is recommended. For unfit patients, carboplatin combination chemotherapy or single agents can be used.
  
  
  CONCLUSIONS
  This 2013 EAU Muscle-invasive and Metastatic BCa guidelines updated summary aims to increase the quality of care and outcome for patients with muscle-invasive or metastatic BCa.
  
  
  RESULTS
  In this paper we update the EAU guidelines on Muscle-invasive and Metastatic bladder cancer. We recommend that chemotherapy be administered before radical treatment and that bladder removal be the standard of care for disease confined to the bladder.
authors.affiliation: Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. Electronic address: f.witjes@uro.umcn.nl.
authors.forename: J Alfred
authors.initials: JA
authors.lastname: Witjes
authors.affiliation: Department of Pathology, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
authors.forename: Eva
authors.initials: E
authors.lastname: Compérat
authors.affiliation: Department of Radiology, The Manor Hospital, Oxford, UK.
authors.forename: Nigel C
authors.initials: NC
authors.lastname: Cowan
authors.affiliation: 3rd Medical Department and ACR-ITR and LBI-ACR Vienna-CTO, Kaiser Franz Josef Spital, Vienna, Austria.
authors.forename: Maria
authors.initials: M
authors.lastname: De Santis
authors.affiliation: Department of Urology, Eberhard-Karls-University Tuebingen, Tuebingen, Germany.
authors.forename: Georgios
authors.initials: G
authors.lastname: Gakis
authors.affiliation: Hôpital Foch, Department of Urology, University of Versailles-Saint-Quentin-en-Yvelines, Suresnes, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Lebret
authors.affiliation: Uro-Oncology Unit, Urology Department, Hospital Clinic, University of Barcelona, Barcelona, Spain.
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Ribal
authors.affiliation: Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: Antoine G
authors.initials: AG
authors.lastname: Van der Heijden
authors.affiliation: Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden.
authors.forename: Amir
authors.initials: A
authors.lastname: Sherif
mesh_terms: D003131:Combined Modality Therapy; D015653:Cystectomy / Q000379:methods; D006801:Humans; D019042:Muscle Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000628:therapy; D009361:Neoplasm Invasiveness; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy*
keywords: Bladder cancer; Bladder sparing treatments; Chemotherapy; Cisplatin-based; Comorbidities; Cystectomy; EAU guidelines; Infiltrative; Invasive; Quality of life