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Bladder Preservation Strategies in Muscle-invasive Bladder Cancer: Recommendations from the International Bladder Cancer Group

Gupta, S.
; 
Hensley, P. J.
; 
Li, R.
; 
Choudhury, A.
; 
Daneshmand, S.
; 
Faltas, B. M.
; 
Flaig, T. W.
; 
Grass, G. D.
; 
Grivas, P.
; 
Hansel, D. E.
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Abstract
BACKGROUND AND OBJECTIVE: Patient-centric management necessitates providing care aligned with patients' values, preferences, and expressed needs. Therefore, critical assessment of bladder preservation therapies (BPTs) as alternatives to radical cystectomy (RC) for muscle-invasive bladder cancer (MIBC) and practical recommendations on the optimal selection of patients for BPTs are needed urgently. METHODS: A global committee of bladder cancer experts was assembled to develop BPT recommendations for MIBC. Working groups reviewed the literature and drafted recommendations, which were voted on by International Bladder Cancer Group (IBCG) members using a modified Delphi process. During a live meeting in August 2023, voting results and supporting evidence were presented, and recommendations were refined based on discussions. Final recommendations achieved ≥75% agreement during the meeting, with further refinements through web conferences and e-mail discussions. KEY FINDINGS AND LIMITATIONS: Patients with newly diagnosed MIBC should be offered evaluation in a multidisciplinary setting for consideration of BPTs. The main alternative to RC is trimodal therapy (TMT), and favorable prognostic factors for TMT include unifocal cT2 stage, lack of hydronephrosis, and no multifocal carcinoma in situ (CIS). Other options should be reserved for very select patients who are ineligible for or who decline TMT or RC after thorough consideration of benefits versus risks. These include partial cystectomy (PC) for urachal adenocarcinoma and PC or radical transurethral resection alone for solitary tumors amenable to resection with adequate margins and without concomitant CIS or histologic subtypes. CONCLUSIONS AND CLINICAL IMPLICATIONS: The IBCG consensus recommendations provide practical guidance on BPTs for MIBC.
Authors
Gupta, S.
Hensley, P. J.
Li, R.
Choudhury, A.
Daneshmand, S.
Faltas, B. M.
Flaig, T. W.
Grass, G. D.
Grivas, P.
Hansel, D. E.
Hassanzadeh, C.
Kassouf, W.
Kukreja, J.
Mendoza-Valdés, A.
Moschini, M.
Mouw, K. W.
Navai, N.
Necchi, A.
Rosenberg, J. E.
Ross, J. S.
Siefker-Radtke, A. O.
Taylor, J.
Willliams, S. B.
Zlotta, A. R.
Buckley, R.
Kamat, A. M.
Affiliation
Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA. Department of Urology, University of Kentucky College of Medicine, Lexington, KY, USA. Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA. Division of Cancer Sciences, University of Manchester, Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, England, UK. Department of Urology, University of Southern California Keck School of Medicine, Norris Comprehensive Cancer Center, Los Angeles, CA, USA. Division of Hematology & Medical Oncology, Weill Cornell Medical College, New York City, NY, USA. Department of Medicine, Division of Medical Oncology, University of Colorado School of Medicine, Aurora, CO, USA. Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA. Division of Hematology Oncology, Department of Medicine, University of Washington School of Medicine, Fred Hutchinson Cancer Center, Seattle, WA, USA. Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. Department of Genitourinary Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. Division of Urology, McGill University, Montreal, Quebec, Canada. University of Colorado Anschutz Medical Campus, Denver, CO, USA. Urology Department, Hospital Medica Sur, Mexico City, Mexico. Division of Oncology/Unit of Urology, URI IRCCS Ospedale San Raffaele, Milan, Italy. Department of Radiation Oncology, Dana-Farber Cancer Institute & Brigham and Women's Hospital & Harvard Medical School, Boston, MA, USA. Division of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. Vita-Salute San Raffaele University, Milan Italy, Department of Medical Oncology, IRCC San Raffaele Hospital, Milan, Italy. Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY, USA. Urology and Medicine (Oncology), Upstate Medical University, Syracuse, NY, USA; Foundation Medicine, Boston, MA USA. Department of Genitourinary Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA. University of Kansas Cancer Center, Kansas City, KS, USA. Division of Urology, The University of Texas Medical Branch (UTMB), Galveston, TX, USA. Division of Urology, Department of Surgery, Sinai Health System, University of Toronto, Toronto, Ontario, Canada; Department of Surgical Oncology, Princess Margaret Cancer Centre, University Heath Network, University of Toronto, Toronto, Ontario, Canada. North York General Hospital, Toronto, Ontario, Canada. Division of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. Electronic address: akamat@mdanderson.org.
Description
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2025
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All Christie Publications
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Article
Citation
Gupta S, Hensley PJ, Li R, Choudhury A, Daneshmand S, Faltas BM, et al. Bladder Preservation Strategies in Muscle-invasive Bladder Cancer: Recommendations from the International Bladder Cancer Group. Eur Urol. 2025 Apr 22. PubMed PMID: 40268594. Epub 2025/04/24. eng.
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https://christie.openrepository.com/handle/10541/627548
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