title: Updated 2016 EAU Guidelines on Muscle-invasive and Metastatic Bladder Cancer.
abstract: Invasive bladder cancer is a frequently occurring disease with a high mortality rate despite optimal treatment. The European Association of Urology (EAU) Muscle-invasive and Metastatic Bladder Cancer (MIBC) Guidelines are updated yearly and provides information to optimise diagnosis, treatment, and follow-up of this patient population.
  
  
  
  To provide a summary of the EAU guidelines for physicians and patients confronted with muscle-invasive and metastatic bladder cancer.
  
  
  
  An international multidisciplinary panel of bladder cancer experts reviewed and discussed the results of a comprehensive literature search of several databases covering all sections of the guidelines. The panel defined levels of evidence and grades of recommendation according to an established classification system.
  
  
  
  Epidemiology and aetiology of bladder cancer are discussed. The proper diagnostic pathway, including demands for pathology and imaging, is outlined. Several treatment options, including bladder-sparing treatments and combinations of treatment modalities (different forms of surgery, radiation therapy, and chemotherapy) are described. Sequencing of these modalities is discussed. Potential indications and contraindications, such as comorbidity, are related to treatment choice. There is a new paragraph on organ-sparing approaches, both in men and in women, and on minimal invasive surgery. Recommendations for chemotherapy in fit and unfit patients are provided including second-line options. Finally, a follow-up schedule is provided.
  
  
  
  The current summary of the EAU Muscle-invasive and Metastatic Bladder Cancer Guidelines provides an up-to-date overview of the available literature and evidence dealing with diagnosis, treatment, and follow-up of patients with metastatic and muscle-invasive bladder cancer.
  
  
  
  Bladder cancer is an important disease with a high mortality rate. These updated guidelines help clinicians refine the diagnosis and select the appropriate therapy and follow-up for patients with metastatic and muscle-invasive bladder cancer.
authors.affiliation: Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. Electronic address: Fred.Witjes@radboudumc.nl.
authors.forename: J
authors.initials: J
authors.lastname: Alfred Witjes
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: Department of Pathology, Hôpital La Pitié Salpetrière, UPMC, Paris, France.
authors.forename: Eva M
authors.initials: EM
authors.lastname: Compérat
authors.affiliation: Radiology Department, Queen Alexandra Hospital, Portsmouth, UK.
authors.forename: Nigel C
authors.initials: NC
authors.lastname: Cowan
authors.affiliation: University of Warwick, Cancer Research Unit, Coventry, UK; Queen Elizabeth Hospital, Birmingham, UK.
authors.forename: Maria
authors.initials: M
authors.lastname: De Santis
authors.affiliation: Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: Harman Maxim
authors.initials: HM
authors.lastname: Bruins
authors.affiliation: Department of Urology, Hospital Universitario Fundación Alcorcón, Madrid, Spain.
authors.forename: Virginia
authors.initials: V
authors.lastname: Hernández
authors.affiliation: Department of Urology, Hospital Universitario Infanta Sofia, Madrid, Spain.
authors.forename: Estefania Linares
authors.initials: EL
authors.lastname: Espinós
authors.affiliation: Department of Urology, Derriford Hospital, Plymouth, UK.
authors.forename: James
authors.initials: J
authors.lastname: Dunn
authors.affiliation: Hôpital Foch, Department of Urology, University of Versailles-Saint-Quentin-en-Yvelines, Suresnes, France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Rouanne
authors.affiliation: Hôpital Foch, Department of Urology, University of Versailles-Saint-Quentin-en-Yvelines, Suresnes, France.
authors.forename: Yann
authors.initials: Y
authors.lastname: Neuzillet
authors.affiliation: Department of Urology, Tampere University Hospital, Tampere, Finland.
authors.forename: Erik
authors.initials: E
authors.lastname: Veskimäe
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 Urology, Eberhard-Karls University, Tübingen, Germany.
authors.forename: Georgios
authors.initials: G
authors.lastname: Gakis
authors.affiliation: Department of Urology, Hospital Clinic, University of Barcelona, Barcelona, Spain.
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Ribal
mesh_terms: D000276:Adjuvants, Immunologic / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001500:BCG Vaccine / Q000627:therapeutic use*; D002295:Carcinoma, Transitional Cell / Q000473:pathology / Q000556:secondary / Q000628:therapy*; D015653:Cystectomy; D003558:Cystoscopy; D005060:Europe; D006801:Humans; D009130:Muscle, Smooth / Q000473:pathology; D009361:Neoplasm Invasiveness; D009362:Neoplasm Metastasis; D011878:Radiotherapy; D012955:Societies, Medical; D001743:Urinary Bladder / Q000473:pathology; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000628:therapy*; D014572:Urology
chemical_list: D000276:Adjuvants, Immunologic; D001500:BCG Vaccine
keywords: Bladder cancer; Cystectomy; Diagnosis; EAU; Follow-up; Guidelines; Metastatic; Multimodality; Muscle invasive; Treatment