Current Approaches to the Management of Non-Muscle Invasive Bladder Cancer: Comparison of Current Guidelines and Recommendations

Context: The guidelines of the European Association of Urology (EAU), the First International Consultation on Bladder Tumors (FICBT), the National Comprehensive Cancer Network (NCCN), and the American Urological Association (AUA) all provide an excellent evidence-based background for the management of non-muscle invasive bladder cancer (NMIBC). Although there are areas of consensus among the four guidelines, their recommendations vary with respect to important issues surrounding NMIBC. Objective: To provide community urologists with practical and unified guidance on the management of NMIBC through a comprehensive review of current influencing guidelines. Evidence acquisition: A committee of internationally renowned leaders in bladder cancer management, known as the International Bladder Cancer Group (IBCG), was convened in October 2006 to review current literature surrounding the management of NMIBC as well as the current clinical practice guidelines of the EAU, the FICBT, the NCCN and the AUA. Following the inaugural meeting in October 2006, the IBCG met on three subsequent occasions (March 2007, September 2007, and March 2008) to critically analyze and compare the EAU, FICBT, NCCN, and AUA guidelines. Evidence synthesis: The IBCG critically analyzed and summarized the EAU, FICBT, NCCN, and AUA guidelines and identified the key similarities and differences in their recommendations. Conclusions: Established areas of consensus among the four guidelines include the importance of transurethral resection of the bladder tumour (TURBT) and an immediate, postoperative dose of chemotherapy (agent optional) in all patients with NMIBC, as well as the benefit of adjuvant bacillus Calmette-Guérin (BCG) therapy in high-risk disease. However, the four guideline recommendations vary with regard to the following important issues: (1) the definitions of low-, intermediate-, and high-risk disease, and (2) the appropriate management and follow-up of patients in each of these risk categories. Furthermore, there is currently no consensus on the definition and appropriate management strategies for primary intravesical treatment failures among the four guidelines.