Diagnosis and Treatment of Non-Muscle Invasive Bladder Cancer: AUA/SUO Guideline.
OBJECTIVE
Although associated with an overall favorable survival rate, the heterogeneity of non-muscle invasive bladder cancer (NMIBC) affects patients' rates of recurrence and progression. Risk stratification should influence evaluation, treatment and surveillance. This guideline attempts to provide a clinical framework for the management of NMIBC.


METHODS
A systematic review utilized research from the Agency for Healthcare Research and Quality (AHRQ) and additional supplementation by the authors and consultant methodologists. Evidence-based statements were based on body of evidence strength Grade A, B, or C and were designated as Strong, Moderate, and Conditional Recommendations with additional statements presented in the form of Clinical Principles or Expert Opinions.(1) RESULTS: A risk-stratified approach categorizes patients into broad groups of low-, intermediate-, and high-risk. Importantly, the evaluation and treatment algorithm takes into account tumor characteristics and uniquely considers a patient's response to therapy. The 38 statements vary in level of evidence, but none include Grade A evidence, and many were Grade C.


CONCLUSIONS
The intensity and scope of care for NMIBC should focus on patient, disease, and treatment response characteristics. This guideline attempts to improve a clinician's ability to evaluate and treat each patient, but higher quality evidence in future trials will be essential to improve level of care for these patients.
American Urological Association Education and Research, Inc., Linthicum, Maryland.
Sam S
SS
Chang
American Urological Association Education and Research, Inc., Linthicum, Maryland.
Stephen A
SA
Boorjian
American Urological Association Education and Research, Inc., Linthicum, Maryland.
Roger
R
Chou
American Urological Association Education and Research, Inc., Linthicum, Maryland.
Peter E
PE
Clark
American Urological Association Education and Research, Inc., Linthicum, Maryland.
Siamak
S
Daneshmand
American Urological Association Education and Research, Inc., Linthicum, Maryland.
Badrinath R
BR
Konety
American Urological Association Education and Research, Inc., Linthicum, Maryland.
Raj
R
Pruthi
American Urological Association Education and Research, Inc., Linthicum, Maryland.
Diane Z
DZ
Quale
American Urological Association Education and Research, Inc., Linthicum, Maryland.
Chad R
CR
Ritch
American Urological Association Education and Research, Inc., Linthicum, Maryland.
John D
JD
Seigne
American Urological Association Education and Research, Inc., Linthicum, Maryland.
Eila Curlee
EC
Skinner
American Urological Association Education and Research, Inc., Linthicum, Maryland.
Norm D
ND
Smith
American Urological Association Education and Research, Inc., Linthicum, Maryland.
James M
JM
McKiernan
D003131:Combined Modality Therapy; D018450:Disease Progression; D006801:Humans; D009361:Neoplasm Invasiveness; D017410:Practice Guidelines as Topic; D012955:Societies, Medical; D001749:Urinary Bladder Neoplasms / Q000473:pathology* / Q000628:therapy*; D014572:Urology
cystectomy; drug therapy; immunotherapy; urinary bladder neoplasms