Adiposity reduction has cancer-specific and overall health benefits for patients with overweight or obesity. The indiscriminate loss of lean mass accompanying weight loss, however, remains a concern for older patients with cancer. Body composition was evaluated in the Prostate Cancer Active Lifestyle Study, a randomized controlled weight loss trial targeting caloric restriction and increased physical activity among patients with prostate cancer and overweight or obesity on active surveillance. Compared with control individuals, the intervention statistically significantly decreased total fat (-3.4%, 95% CI = -5.3% to -1.5%), android fat (-2.0%, 95% CI = -3.6% to -0.4%), and visceral adipose tissue mass (-613 g, 95% CI = -894 to -331 g) (all 2-sided P < .001), with no difference in lean mass (P = .70) and a statistically significant increase in lean mass to fat ratio (0.40, 95% CI = 0.06 to 0.73; 2-sided P = .02). Weight loss interventions incorporating diet and physical activity among patients with prostate cancer and overweight or obesity can yield statistically significant reductions in adiposity while limiting lean mass loss.

Background: Active surveillance (AS) is increasingly used to monitor patients with lower risk prostate cancer (PCa). The Prostate Cancer Active Lifestyle Study (PALS) was a randomized controlled trial to determine whether weight loss improves obesity biomarkers on the causal pathway to progression in patients with PCa on AS. Methods: Overweight/obese men (body mass index >25 kg/m2) diagnosed with PCa who elected AS were recruited. The intervention was a 6-month, individually delivered, structured diet and exercise program adapted from the Diabetes Prevention Program with a 7% weight loss goal from baseline. Control participants attended one session reviewing the US Dietary and Physical Activity Guidelines. The primary outcome was change in glucose regulation from baseline to the end of the 6-month intervention, which was measured by fasting plasma glucose, C-peptide, insulin, insulin-like growth factor 1, insulin-like growth factor binding protein-3, adiponectin, and homeostatic model assessment for insulin resistance. Results: Among 117 men who were randomized, 100 completed the trial. The mean percentage weight loss was 7.1% and 1.8% in the intervention and control arms, respectively (adjusted between-group mean difference, -6.0 kg; 95% confidence interval, -8.0, -4.0). Mean percentage changes from baseline for insulin, C-peptide, and homeostatic model assessment for insulin resistance in the intervention arm were -23%, -16%, and -25%, respectively, compared with +6.9%, +7.5%, and +6.4%, respectively, in the control arm (all p for intervention effects <= .003). No significant between-arm differences were detected for the other biomarkers. Conclusions: Overweight/obese men with PCa undergoing AS who participated in a lifestyle-based weight loss intervention successfully met weight loss goals with this reproducible lifestyle intervention and experienced improvements in glucose-regulation biomarkers associated with PCa progression.

PURPOSE:Ultrasonic propulsion is an investigational procedure for awake patients. Our purpose was to evaluate whether ultrasonic propulsion to facilitate residual kidney stone fragment clearance reduced relapse. MATERIALS AND METHODS:This multicenter, prospective, open-label, randomized, controlled trial used single block randomization (1:1) without masking. Adults with residual fragments (individually ≤5 mm) were enrolled. Primary outcome was relapse as measured by stone growth, a stone-related urgent medical visit, or surgery by 5 years or study end. Secondary outcomes were fragment passage within 3 weeks and adverse events within 90 days. Cumulative incidence of relapse was estimated using the Kaplan-Meier method. Log-rank test was used to compare the treatment (ultrasonic propulsion) and control (observation) groups. RESULTS:The trial was conducted from May 9, 2015, through April 6, 2024. Median follow-up (interquartile range) was 3.0 (1.8-3.2) years. The treatment group (n = 40) had longer time to relapse than the control group (n = 42; P < .003). The restricted mean time-to-relapse was 52% longer in the treatment group than in the control group (1530 ± 92 days vs 1009 ± 118 days), and the risk of relapse was lower (hazard ratio 0.30, 95% CI 0.13-0.68) with 8 of 40 and 21 of 42 participants, respectively, experiencing relapse. Omitting 3 participants not asked about passage, 24 treatment (63%) and 2 control (5%) participants passed fragments within 3 weeks of treatment. adverse events were mild, transient, and self-resolving, and were reported in 25 treated participants (63%) and 17 controls (40%). CONCLUSIONS:Ultrasonic propulsion reduced relapse and added minimal risk.

3D reconstruction of cystoscopy holds substantial value in the observation and guided treatment of urological conditions. 3D models of the bladder, obtained through the reconstruction, can aid physicians in performing a rapid and comprehensive assessment of various conditions, such as detection of bladder cancer and follow-up surveillance throughout the patients' life. In recent years, significant advancements have been made in 3D reconstruction based on cystoscopy. However, the broader application of these advancements has been hampered by issues such as texture loss, slow computational speed, and susceptibility to interference. In this study, we have achieved, for the first time, a reconstruction of a dynamic cystoscopy scene using Neural Radiance Fields (NeRF). Unlike mesh-based 3D reconstruction, NeRF can restore scenes under conditions where the number of views and features are limited, thereby addressing the problem of texture loss that might arise from traditional 3D reconstruction algorithms. Additionally, to expedite the computation speed of NeRF, we employed Instant-NGP, an open-source software that accelerates NeRF computations using hash encoding. This potentially reduces computation time by a hundredfold, making it several tens of times faster than SfM when camera pose values can be streamed into the NeRF reconstruction. By comparing NeRF and SfM methods, we found that NeRF exhibits stronger resistance to interference than SfM, underscoring the formidable potential of NeRF as an innovative method in the field of endoscopy. In the future of robotic-assisted flexible cystoscopy, NeRF has the potential to provide rapid, robust, and comprehensive recording for remote diagnosis of bladder abnormalities.

You have accessJournal of UrologyStone Disease: Surgical Therapy (Including ESWL) III (MP29)1 May 2024MP29-10 OFFICE-BASED REMOVAL OF SMALL RESIDUAL KIDNEY STONE FRAGMENTS REDUCES RELAPSE RATES Mathew D. Sorensen, Barbrina Dunmire, Jeff Thiel, Bryan W. Cunitz, Barbara H. Burke, Branda J. Levchak, Christina Popchoi, Arturo E. Holmes, John C. Kucewicz, M. Kennedy Hall, Manjiri Dighe, Jessica C. Dai, Fionnuala C. Cormack, Ziyue Liu, Michael R. Bailey, Michael P. Porter, and Jonathan D. Harper Mathew D. SorensenMathew D. Sorensen , Barbrina DunmireBarbrina Dunmire , Jeff ThielJeff Thiel , Bryan W. CunitzBryan W. Cunitz , Barbara H. BurkeBarbara H. Burke , Branda J. LevchakBranda J. Levchak , Christina PopchoiChristina Popchoi , Arturo E. HolmesArturo E. Holmes , John C. KucewiczJohn C. Kucewicz , M. Kennedy HallM. Kennedy Hall , Manjiri DigheManjiri Dighe , Jessica C. DaiJessica C. Dai , Fionnuala C. CormackFionnuala C. Cormack , Ziyue LiuZiyue Liu , Michael R. BaileyMichael R. Bailey , Michael P. PorterMichael P. Porter , and Jonathan D. HarperJonathan D. Harper View All Author Informationhttps://doi.org/10.1097/01.JU.0001008680.67760.37.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The benefit of removing residual kidney stone fragments is unknown. U.S. urology guidelines recommend imaging after surgery to detect fragments and offering a second endoscopic surgery to remove fragments as patients with fragments frequently require additional clinical care. Human feasibility studies and randomized clinical trials have shown fragments may be removed by nonsurgical, noninvasive technologies. METHODS: In a multi-center, randomized, controlled trial, 82 adults with residual kidney stone fragments (individually≤5 mm) were randomized to receive a noninvasive, nonsurgical investigative procedure to attempt to facilitate fragment clearance or no procedure and observation of their fragments (ClinicalTrials.gov number, NCT02028559). The primary outcome was relapse as measured by future symptomatic, unscheduled medical visits, surgeries, or stone growth measured on annual CT exams. RESULTS: Demographic and clinical characteristics were similar (Table 1). After a median follow-up of 2.4 years, the risk of relapse was 68% lower in the treatment group than the control group (odds ratio 0.32, 95% confidence interval 0.14-0.73) with absolute difference in relapse of 20% vs. 48% (treatment versus control). The treatment group had 51% longer time-to-relapse than controls (restricted mean of 1505±99 days for treatment vs 995±120 days for control, p<0.004, log-rank test) (Figure 1). Excluding 3 participants not asked about passage, asymptomatic passage of fragments within the first 3 weeks was over 12-fold higher in the treatment group (n=24, 63%) compared to control (n=2, 5%). After 3 weeks, asymptomatic passage was similar between groups (n=10 treatment vs 12 control subjects). Average number of treatments was 1.35. Adverse events were mild and transient and included 1 report of a bruise and 11 cases of mild discomfort. CONCLUSIONS: Removal of residual fragments by ultrasonic propulsion added minimal risk and reduced relapse. Download PPT Source of Funding: Funding provided by the NIH NIDDK P01 DK043881 and the Puget Sound Veterans Affairs © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e484 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Mathew D. Sorensen More articles by this author Barbrina Dunmire More articles by this author Jeff Thiel More articles by this author Bryan W. Cunitz More articles by this author Barbara H. Burke More articles by this author Branda J. Levchak More articles by this author Christina Popchoi More articles by this author Arturo E. Holmes More articles by this author John C. Kucewicz More articles by this author M. Kennedy Hall More articles by this author Manjiri Dighe More articles by this author Jessica C. Dai More articles by this author Fionnuala C. Cormack More articles by this author Ziyue Liu More articles by this author Michael R. Bailey More articles by this author Michael P. Porter More articles by this author Jonathan D. Harper More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyParadigm-shifting, Practice-changing Clinical Trials in Urology (P2)1 May 2024P2-11 OFFICE-BASED REMOVAL OF SMALL URINARY STONES Mathew D. Sorensen, Barbrina Dunmire, Jeff Thiel, Bryan W. Cunitz, Barbara H. Burke, Branda J. Levchak, Christina Popchoi, Arturo E. Holmes, John C. Kucewicz, M. Kennedy Hall, Manjiri Dighe, Jessica C. Dai, Fionnuala C. Cormack, Ziyue Liu, Michael R. Bailey, Michael P. Porter, and Jonathan D. Harper Mathew D. SorensenMathew D. Sorensen , Barbrina DunmireBarbrina Dunmire , Jeff ThielJeff Thiel , Bryan W. CunitzBryan W. Cunitz , Barbara H. BurkeBarbara H. Burke , Branda J. LevchakBranda J. Levchak , Christina PopchoiChristina Popchoi , Arturo E. HolmesArturo E. Holmes , John C. KucewiczJohn C. Kucewicz , M. Kennedy HallM. Kennedy Hall , Manjiri DigheManjiri Dighe , Jessica C. DaiJessica C. Dai , Fionnuala C. CormackFionnuala C. Cormack , Ziyue LiuZiyue Liu , Michael R. BaileyMichael R. Bailey , Michael P. PorterMichael P. Porter , and Jonathan D. HarperJonathan D. Harper View All Author Informationhttps://doi.org/10.1097/01.JU.0001015816.87470.c9.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: We investigate changing practice to treat small stones and fragments. We published that removing by ureteroscopy small, asymptomatic renal stones during surgery for ureteral or contralateral renal stones reduced relapse by 82% in 4-year follow-up [NEJM 2022;387:506-513]. Here we report relapse following ultrasonic propulsion - noninvasive, nonsurgical treatment - to reposition small, asymptomatic residual fragments to facilitate clearance. We have begun studies adding burst wave lithotripsy to ultrasonic propulsion in the same device to break ureteral and renal stones and reposition fragments to facilitate clearance in awake patients. METHODS: In a multi-center, randomized, controlled trial, 82 adults with residual kidney stone fragments (individually ≤5 mm) were randomized to receive ultrasonic propulsion to attempt to facilitate fragment clearance or no procedure and observation of their fragments (ClinicalTrials.gov NCT02028559). The primary outcome was relapse as measured by future symptomatic, unscheduled medical visits, surgeries, or stone growth measured on annual CT exams. RESULTS: Demographic and clinical characteristics were similar (Table 1). After a mean follow-up of 2.6 years, the risk of relapse was 70% lower in the treatment group than the control group (hazard ratio 0.30, 95% confidence interval 0.13-0.68) with absolute difference in relapse of 20% vs. 50% (treatment vs. control). The treatment group had 52% longer time-to-relapse than controls (restricted mean of 1530 ± 92 days for treatment vs. 1009 ± 118 days for control, p<0.003, log-rank test) (Fig. 1). Excluding 3 participants not asked about passage, passage of fragments within the first 3 weeks was over 12-fold higher in the treatment group (24 of 38, 63%) compared to control (2 of 41, 5%). Adverse events were mild and transient and were reported in 25 (63%) of 40 patients in the treatment group and 17 (40%) of 42 patients in the control group. CONCLUSIONS: Removal of residual fragments by ultrasonic propulsion added minimal risk and reduced relapse. Download PPT Source of Funding: Funding provided by the NIH NIDDK P01 DK043881 and the Puget Sound Veterans Affairs © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5S2May 2024Page: e7 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Mathew D. Sorensen More articles by this author Barbrina Dunmire More articles by this author Jeff Thiel More articles by this author Bryan W. Cunitz More articles by this author Barbara H. Burke More articles by this author Branda J. Levchak More articles by this author Christina Popchoi More articles by this author Arturo E. Holmes More articles by this author John C. Kucewicz More articles by this author M. Kennedy Hall More articles by this author Manjiri Dighe More articles by this author Jessica C. Dai More articles by this author Fionnuala C. Cormack More articles by this author Ziyue Liu More articles by this author Michael R. Bailey More articles by this author Michael P. Porter More articles by this author Jonathan D. Harper More articles by this author Expand All Advertisement PDF downloadLoading ...

Platinum-based NAC followed by cystectomy is standard of care for MIBC, however improvement of response rates is needed. In this phase I/II trial, neoadjuvant gemcitabine-cisplatin-rapamycin combination was used to suppress response to platinum-derived DNA damage by the tumor microenvironment. Although rapamycin successfully suppressed damage response, treatment efficacy did not improve, suggesting the existence of alternative platinum resistance pathways.Introduction: Cisplatin-based neoadjuvant chemotherapy (NAC) followed by cystectomy is the standard for muscle -invasive bladder cancer (MIBC), however, NAC confers only a small survival benefit and new strategies are needed to increase its efficacy. Pre-clinical data suggest that in response to DNA damage the tumor microenvironment (TME) adopts a paracrine secretory phenotype dependent on mTOR signaling which may provide an escape mechanism for tumor resistance, thus offering an opportunity to increase NAC effectiveness with mTOR blockade. Patients & Methods: We conducted a phase I/II clinical trial to assess the safety and efficacy of gemcitabine-cisplatin-rapamycin combination. Grapefruit juice was administered to enhance rapamycin pharmacokinetics by inhibiting intestinal enzymatic degrada-tion. Phase I was a dose determination/safety study followed by a single arm Phase II study of NAC prior to radical cystectomy evaluating pathologic response with a 26% pCR rate target. Results: In phase I, 6 patients enrolled, and the phase 2 dose of 35 mg rapamycin established. Fifteen patients enrolled in phase II; 13 were evaluable. Rapamycin was tolerated without serious adverse events. At the preplanned analysis, the complete response rate (23%) did not meet the prespecified level for continuing and the study was stopped due to futility. With immunohistochemistry, successful suppression of the mTOR signaling pathway in the tumor was achieved while limited mTOR activity was seen in the TME. Conclusion: Adding rapamycin to gemcitabine-cisplatin therapy for patients with MIBC was well tolerated but failed to improve therapeutic efficacy despite evidence of mTOR blockade in tumor cells. Further efforts to understand the role of the tumor microenvironment in chemotherapy resistance is needed.Clinical Genitourinary Cancer, Vol. 21, No. 2, 265-272 (c) 2022 Published by Elsevier Inc.

Telecystoscopy can lower the barrier to access critical urologic diagnostics for patients around the world. A major challenge for robotic control of flexible cystoscopes and intuitive teleoperation is the pose estimation of the scope tip. We propose a novel real-time camera localization method using video recordings from a prior cystoscopy and 3D bladder reconstruction to estimate cystoscope pose within the bladder during follow-up telecystoscopy. We map prior video frames into a low-dimensional space as a dictionary so that a new image can be likewise mapped to efficiently retrieve its nearest neighbor among the dictionary images. The cystoscope pose is then estimated by the correspondence among the new image, its nearest dictionary image, and the prior model from 3D reconstruction. We demonstrate performance of our methods using bladder phantoms with varying fidelity and a servo-controlled cystoscope to simulate the use case of bladder surveillance through telecystoscopy. The servo-controlled cystoscope with 3 degrees of freedom (angulation, roll, and insertion axes) was developed for collecting cystoscope videos from bladder phantoms. Cystoscope videos were acquired in a 2.5D bladder phantom (bladder-shape cross-section plus height) with a panorama of a urothelium attached to the inner surface. Scans of the 2.5D phantom were performed in separate arc trajectories each of which is generated by actuation on the angulation with a fixed roll and insertion length. We further included variance in moving speed, imaging distance and existence of bladder tumors. Cystoscope videos were also acquired in a water-filled 3D silicone bladder phantom with hand-painted vasculature. Scans of the 3D phantom were performed in separate circle trajectories each of which is generated by actuation on the roll axis under a fixed angulation and insertion length. These videos were used to create 3D reconstructions, dictionary sets, and test data sets for evaluating the computational efficiency and accuracy of our proposed method in comparison with a method based on global Scale-Invariant Feature Transform (SIFT) features, named SIFT-only. Our method can retrieve the nearest dictionary image for 94–100% of test frames in under 55[Formula: see text]ms per image, whereas the SIFT-only method can only find the image match for 56–100% of test frames in 6000–40000[Formula: see text]ms per image depending on size of the dictionary set and richness of SIFT features in the images. Our method, with a speed of around 20 Hz for the retrieval stage, is a promising tool for real-time image-based scope localization in robotic cystoscopy when prior cystoscopy images are available.

Telecystoscopy can lower the barrier to access of critical urologic diagnostics for patients around the world. A challenge to robotic control of flexible cystoscopes and intuitive teleoperation is estimation of the pose of the scope tip. We demonstrate real-time localization using video recordings from prior cystoscopies and 3D reconstructions of the patient’s bladder to estimate cystoscope angulation We map prior video data into a low dimensional space as a dictionary so that new images can be matched to a nearest neighbor. The cystoscope position is estimated by the current image’s relationship to a matched dictionary frame. Frequent cystoscopies are necessary in post-treatment surveillance of bladder cancer patients, and video from previous procedures may be available during telecystoscopy. A cystoscope with servo-controlled angulation was inserted into a 2D + height bladder shape with a panorama of a urothelium on to the inside. Scans of the surface were performed with: varying speeds; different fields of view; and bladder tumors inserted into the panorama physically and digitally. Videos were used to create 3D reconstructions, dictionary sets, and test data sets for analyzing our algorithm’s computational efficiency and accuracy compared with a SIFT-only localization. Our algorithm found a nearest neighbor image in 96-100% of frames in under 60ms per image compared to SIFT’s ability to find an image match in 56-84% of frames in more than 6000ms per image. Our algorithm, with a first stage rate of nearly 20 Hz, is a promising tool for real-time estimation of tip location in robotic cystoscopy when prior cystoscopy images are available.

The goal is to test effectiveness and safety of transcutaneous ultrasound pulses for facilitating clearance of residual urinary stone fragments in a randomized control trial (RCT). The study is conducted in a clinic setting with the control and treatment arms undergoing all the same activities with the exception of the ultrasonic propulsion procedure and associated pain questionnaire. Subjects are followed 90 days for assessment of adverse events and for up to 5 years for stone growth and symptomatic stone visits. Twenty-six of 33 subjects have been recruited in each arm The most recent treatment is reported. The subject received shock wave lithotripsy and did not pass any fragments for 17 months. The subject was randomized to the treatment arm. Fragments began moving with the third 3-s propulsion pulse at output 2 of 5 levels. Fifty-two percent of propulsion pulses (41 of 79) resulted in fragment movement. The subject reported no pain at the beginning or end of the procedure and telephoned within 2 h to report passing 9 fragments, no hematuria, and no adverse events. The treatment results of this RCT are compelling as an immediate and casual effect was measured. [Work supported by NIH-P01-DK043881 and VA Puget Sound resources.]

Tyler J. Nelson, BS; Juan Javier-DesLoges, MD, MS; Rishi Deka, PhD; P. Travis Courtney, MAS; Vinit Nalawade, MS; Loren Mell, MD; James Murphy, MD; J. Kellogg Parsons, MD, MHS; Brent S. Rose, MD

Active surveillance (AS) is increasingly used to monitor patients with low-risk prostate cancer; however, approximately 50% of AS patients experience disease reclassification requiring definitive treatment and little is known about patient characteristics that modify the risk of reclassification. Obesity may be one of the major contributing factors. The Prostate Cancer Active Lifestyle Study (PALS) is a clinical trial evaluating the impact of weight loss among overweight/obese (Body Mass Index (BMI) ≥ 25 kg/m2) men with clinically localized prostate cancer on AS. Two hundred participants will be randomized to either the PALS intervention, a 6-month structured diet and exercise program adapted from the Diabetes Prevention Program followed by 6 months of maintenance, or control (general diet and physical activity guidelines delivered in a single session). The PALS intervention involves one-on-one instruction with a registered dietitian and exercise physiologist to achieve the study goal of loss of 7% of baseline weight. Participation is coordinated so that the 6-month time point coincides with the participants' standard-of-care AS prostate biopsy. Primary outcomes will evaluate the intervention effects on circulating and tissue markers of glucose and insulin regulation, health-related quality of life and pathologic upgrading on follow-up prostate biopsies. Additional analyses will determine whether changes in weight and glucose regulation can be sustained for 6 months after the end of instruction. Findings from this trial may have wide reaching implications for men diagnosed with clinically-localized prostate cancer by providing an active lifestyle-based approach to improve prostate cancer patient outcomes.

BACKGROUND Active surveillance (AS) has been widely implemented within Veterans Affairs' medical centers (VAMCs) as a standard of care for low-risk prostate cancer (PCa). Patient characteristics such as age, race, and Agent Orange (AO) exposure may influence advisability of AS in veterans. The 17-gene assay may improve risk stratification and management selection. OBJECTIVES To compare management strategies for PCa at 6 VAMCs before and after introduction of the Oncotype DX Genomic Prostate Score (GPS) assay. STUDY DESIGN We reviewed records of patients diagnosed with PCa between 2013 and 2014 to identify management patterns in an untested cohort. From 2015 to 2016, these patients received GPS testing in a prospective study. Charts from 6 months post biopsy were reviewed for both cohorts to compare management received in the untested and tested cohorts. SUBJECTS Men who just received their diagnosis and have National Comprehensive Cancer Network (NCCN) very low-, low-, and select cases of intermediate-risk PCa. RESULTS Patient characteristics were generally similar in the untested and tested cohorts. AS utilization was 12% higher in the tested cohort compared with the untested cohort. In men younger than 60 years, utilization of AS in tested men was 33% higher than in untested men. AS in tested men was higher across all NCCN risk groups and races, particular in low-risk men (72% vs 90% for untested vs tested, respectively). Tested veterans exposed to AO received less AS than untested veterans. Tested nonexposed veterans received 19% more AS than untested veterans. Median GPS results did not significantly differ as a factor of race or AO exposure. CONCLUSIONS Men who receive GPS testing are more likely to utilize AS within the year post diagnosis, regardless of age, race, and NCCN risk group. Median GPS was similar across racial groups and AO exposure groups, suggesting similar biology across these groups. The GPS assay may be a useful tool to refine risk assessment of PCa and increase rates of AS among clinically and biologically low-risk patients, which is in line with guideline-based care.

The NCCN Clinical Practice Guidelines in Oncology for Bladder Cancer provide recommendations for the diagnosis, evaluation, treatment, and follow-up of patients with bladder cancer. These NCCN Guidelines Insights discuss important updates to the 2018 version of the guidelines, including implications of the 8th edition of the AJCC Cancer Staging Manual on treatment of muscle-invasive bladder cancer and incorporating newly approved immune checkpoint inhibitor therapies into treatment options for patients with locally advanced or metastatic disease.

Just as there is no such thing as good marketing or good manufacturing, there is no such thing as good primary care — it completely depends on how that care is tailored to meet the needs of patient...

The NCCN Clinical Practice Guidelines in Oncology for Bladder Cancer provide recommendations for the diagnosis, evaluation, treatment, and follow-up of patients with bladder cancer. These NCCN Guidelines Insights discuss important updates to the 2018 version of the guidelines, including implications of the 8th edition of the AJCC Cancer Staging Manual on treatment of muscle-invasive bladder cancer and incorporating newly approved immune checkpoint inhibitor therapies into treatment options for patients with locally advanced or metastatic disease.

This selection from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Bladder Cancer focuses on systemic therapy for muscle-invasive urothelial bladder cancer, as substantial revisions were made in the 2017 updates, such as new recommendations for nivolumab, pembrolizumab, atezolizumab, durvalumab, and avelumab. The complete version of the NCCN Guidelines for Bladder Cancer addresses additional aspects of the management of bladder cancer, including non-muscle-invasive urothelial bladder cancer and nonurothelial histologies, as well as staging, evaluation, and follow-up.