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BACKGROUND AND OBJECTIVE: Assessment of patients with hematuria (aH) remains a challenge in urological practice, balancing the benefits of diagnosing a potentially underlying bladder cancer (UCa) against the risks of possibly unnecessary diagnostic interventions. This study analyzes the potential of an mRNA-based urine assay, the Xpert® Bladder Cancer Detection- CE-IVD (Xpert BC-D), in patients with hematuria. MATERIALS AND METHODS: Overall, 368 patients with newly observed painless hematuria and no history of UCa were included in this observational study. Patients received urological workup, including urethrocystoscopy (WLC), upper tract imaging, urine cytology and Xpert BC-D. Patients with positive WLC were recommended to undergo tumor resection (TUR-B). RESULTS: After excluding non-assessable cases, 324 patients were considered for analysis (188 males, 136 females; median age: 61 years). Eight of twenty-eight patients with a positive TUR-B had Ta low grade (LG) tumors; the others were diagnosed with high grade (HG) lesions (Ta: 4, CIS: 2, T1:11, >âT1:3). The Xpert BC-D was more sensitive than urine cytology (96% vs. 61%) (pâ=â0.002). Increased risk ratios (RR) were observed for gross hematuria, gender, urine cytology, and positive Xpert BC-D (all pâ<â0.05). Age and positive Xpert BC-D remained independent predictors of UCa in multivariate analysis. Simulating a triage with WLC restricted to patients with positive Xpert BC-D could have saved 240 (74.1%) assessments at the cost of missing one pTa LG tumor. CONCLUSIONS: The results suggest a potential role for Xpert BC-D in preselecting patients with hematuria for either further invasive diagnosis or an alternate diagnostic procedure.
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A plethora of urine markers for the management of patients with bladder cancer has been developed and studied in the past. However, the clinical impact of urine testing on patient management remains obscure. The goal of this manuscript is to identify scenarios for the potential use of molecular urine markers in the follow-up of patients with high-risk non-muscle-invasive BC (NMIBC) and estimate potential risks and benefits. Information on the course of disease of patients with high-risk NMIBC and performance data of a point-of-care test (UBC rapid™), an MCM-5 directed ELISA (ADXBLADDER™), and 2 additional novel assays targeting alterations of mRNA expression and DNA methylation (Xpert bladder cancer monitor™, Epicheck™) were retrieved from high-quality trials and/or meta-analyses. In addition, the sensitivity of white light cystoscopy (WLC) and the impact of a urine marker result on the performance of WLC were estimated based on fluorescence cystoscopy data and information from the CeFub trial. This information was applied to different scenarios in patient follow-up and sensitivity, estimated number of cystoscopies, and the numbers needed to diagnose were calculated. The sensitivity of guideline-based regular follow-up (SOC) at 1 year was calculated at 96%. For different marker-supported strategies sensitivities ranging from 77% to 97.9% were estimated. Calculations suggest that several strategies are effective for the SOC. While for the SOC 24.6 WLCs were required to diagnose 1 tumor recurrence (NND), this NND dropped below 5 in some marker-supported strategies. Based on the results of this simulation, a marker-supported follow-up of patients with HR NMIBC is safe and offers the option to significantly reduce the number of WLCs. Further research focusing on prospective randomized trials is needed to finally find a way to implement urine markers into clinical decision-making.
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Biomarcadores Tumorais , Neoplasias da Bexiga Urinária , Neoplasias da Bexiga Urinária/urina , Neoplasias da Bexiga Urinária/patologia , Humanos , Biomarcadores Tumorais/urina , Seguimentos , Invasividade Neoplásica , Neoplasias não Músculo Invasivas da BexigaRESUMO
BACKGROUND: Although a plethora of urine markers for diagnosis and follow-up of patients with bladder cancer (BC) has been developed and studied, the clinical impact of urine testing on patient management remains unclear. The goal of this manuscript is to identify scenarios for a potential use of modern point-of-care (POC) urine marker assays in the follow-up of patients with high-risk non-muscle-invasive BC (NMIBC) and estimate potential risks and benefits. METHODS: To permit comparison between different assays, the results of 5 different POC assays studied in a recent prospective multicenter study including 127 patients with suspicious cystoscopy undergoing TURB were used for this simulation. For the current standard of care (SOC), a "marker-enforced" procedure, and a combined strategy sensitivity (Se), estimated number of cystoscopies, and the numbers needed to diagnose (NND) over a 1-year follow-up period were calculated. RESULTS: For regular cystoscopy (SOC), a Se of 91.7% and a NND of 42.2 repetitive office cystoscopies (WLCs) for 1 recurrent tumor at 1 year were calculated. For the "marker-enforced" strategy, marker sensitivities between 94.7% and 97.1% were observed. The "combined" strategy yielded for markers with a Se exceeding 50% an overall Se at 1 year similar or superior to the current SOC. Savings regarding the number of cystoscopies in the "marker-enforced" strategy vs. the SOC were small, while, depending on the marker, up to 45% of all cystoscopies may be saved using the "combined" strategy. CONCLUSIONS: Based on the results of this simulation, a marker-supported follow-up of patients with high-risk (HR) NMIBC is safe and offers options to significantly reduce the number of cystoscopies without compromising the Se. Further research focusing on prospective randomized trials is needed to finally find a way to include marker results into clinical decision-making.
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Neoplasias não Músculo Invasivas da Bexiga , Neoplasias da Bexiga Urinária , Humanos , Seguimentos , Estudos Prospectivos , Sistemas Automatizados de Assistência Junto ao Leito , Biomarcadores Tumorais , Neoplasias da Bexiga Urinária/diagnóstico , Neoplasias da Bexiga Urinária/patologiaRESUMO
In 1997 an international group of scientists organized a meeting in Barcelona, Spain, to discuss the use of biomarkers in the management of patients with bladder cancer. This meeting was the offspring of an - initially informal - group that finally resulted in the foundation and incorporation of the International Bladder Cancer Network (IBCN) e.V. in 2005. Over the years the group has supported several research initiatives and generated several recommendations on the use of biomarkers in the diagnosis and treatment of bladder cancer. Meeting quality was generated by inviting experts presenting state-of-the-art lectures or work in progress reports, interdisciplinarity and the limited number of participants supporting an open and personal exchange resulted in a format increasingly attracting participants from all over the world. The recent limitations caused by the Covid-19 pandemic were partially met by organizing several well attended webinars. The future challenge is to maintain the IBCN meeting spirit despite an increasing interest of the scientific community and industrial partners to participate. However, the integration of and interaction between increasingly more specialized disciplines is a challenge that can be better catalyzed by an international multidisciplinary network than mostly national professional associations.
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COVID-19 , Neoplasias da Bexiga Urinária , Humanos , Pandemias , Biomarcadores , Neoplasias da Bexiga Urinária/diagnóstico , Neoplasias da Bexiga Urinária/terapia , EspanhaRESUMO
BACKGROUND & OBJECTIVE: Asymptomatic microhematuria (aMh) remains a diagnostic challenge in urological practice: while aMh is a risk factor of urothelial carcinoma (UC), prevalence of aMh is high. Guidelines were developed to permit risk stratification and reduce diagnostic workload. This study investigates the efficacy of several recommendations. MATERIAL & METHODS: Sixty hundred eight patients with newly diagnosed aMh without previous UC from an academic referral center (A; nâ¯=â¯320) and a private outpatient clinic (B; nâ¯=â¯288) were included. All patients underwent clinical workup including medical history, urine cytology, upper tract imaging and cystoscopy. Eleven former and current guidelines were applied to each patient individually; every patient was classified as either low risk (no further workup recommended) or high risk. Furthermore, a recently developed nomogram for hematuria assessment was included. RESULTS: The cohort comprised 142 females and 466 males (mean age 62 [range 18-92] years). Sixty-one patients (10.0%) were diagnosed with UC. Excluding the Swedish and recent NICE guideline generally advising against urologic workup, application of 9 other recommendations would have diagnosed all UCs and saved 1.6% to 16.1% of patients from workup. For the 2020 US guideline, solely applied to cohort B, 10.6% of patients were classified as low risk. The use of the nomogram would have saved 17.1% to 25% of patients from workup. CONCLUSIONS: Practical relevance of current guidelines is limited as they do not sufficiently identify patients not requiring clinical work up. Thus, guideline adherence may trigger overdiagnosis and even overtreatment. New ways of risk stratification are needed to improve aMh assessment.
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Doenças Assintomáticas , Hematúria , Sobrediagnóstico , Guias de Prática Clínica como Assunto , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Hematúria/diagnóstico , Hematúria/terapia , Fatores de Risco , Sobrediagnóstico/prevenção & controle , Sobrediagnóstico/estatística & dados numéricosRESUMO
Androgen deprivation therapy (ADT) in men with prostate cancer (PCa) is associated with significant side effects. With the transition of PCa from a foudroyant course to a chronic disease, managing these side effects has become increasingly important. There is growing evidence that nutritional changes and physical activity are beneficial in these patients. Here we examine the impact of written patient information on the physical activity and dietary habits of PCa patients receiving ADT and behaviour changes between baseline and 1 year, in the open-label, non-interventional LEAN study. In total, 959 patients with advanced hormone-sensitive PCa requiring ADT with the Leuprorelin Sandoz® implant were included from January 2014 to July 2015 and followed for ≥ 12 months. At the start of the study, urologists received a questionnaire concerning the written information provided to patients regarding their disease, patient advocacy groups, diet and physical activity. Patients received a questionnaire on their dietary habits and physical activity at the start and end of the study. Urologists from 147 study centres and 540 patients responded to the questionnaires. While 69 % of these patients received disease-specific information, only 30 % and 17 % received information regarding nutrition and physical activity, respectively. The majority of urologists estimate that their patients rarely or never follow guidance on nutrition or physical activity, yet > 90 % of patients indicate they would make use of this information, if provided. Few patients showed behavioural changes between baseline and 1 year without evident differences between patients that received information and those that did not.
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Neoplasias da Próstata , Humanos , Masculino , Antagonistas de Androgênios/efeitos adversos , Estilo de Vida , Neoplasias da Próstata/tratamento farmacológicoRESUMO
Marker research, and in particular urine bladder cancer marker research throughout the past three decades, devours enormous scientific resources in terms of manpower (not to mention time spent on reviewing and editorial efforts) and financial resources, finally generating large numbers of manuscripts without affecting clinical decision making. This is mirrored by the fact that current guidelines do not recommend marker use due to missing level 1 evidence. Although we recognize the problems and obstacles, the authors of this commentary feel that the time has come to abandon the current procedures and move on to prospective trial designs implementing marker results into clinical decision making. Our thoughts and concerns are summarized in this comment.
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The hypereosinophilic syndrome (HES) is a rare disorder characterized by hypereosinophilia and infiltration of various organs with eosinophils. Eosinophilic cystitis (EC), mimicking bladder cancer clinically but also in ultrasound and in radiographic imaging, is one potential manifestation of the HES occurring in adults as well as in children. This case report describes the course of disease in a 57-year-old male presenting with severe gait disorders and symptoms of a low compliance bladder caused by a large retropubic tumor. After extensive urine and serologic examination and histologic confirmation of EC the patient was subjected to medical treatment with cetirizine and prednisolone for 5 weeks. While gait disorders rapidly resolved, micturition normalized only 10 months after initiation of therapy. Based upon this course the authors recommend patience and reluctance concerning radical surgical intervention in EC. Key Points ⢠Eosinophilic cystitis is a rare condition with app. 200 cases reported, so far. ⢠Etiology of eosinophilic cystitis is obscure, but allergies and parasitic infections may trigger the disease. ⢠Genetic alterations (e.g., BRAF mutations) may predispose for the disease ⢠Corticosteroids and antihistamines are the backbone of therapy and may be complemented by antibiotics and non-steroidal anti-inflammatory drugs in case of concomitant (underlying) infections. ⢠As recovery can occur even after a long time, radical surgery should be restricted to highly selected cases.
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Cistite/diagnóstico , Síndrome Hipereosinofílica/diagnóstico , Neoplasias da Bexiga Urinária/diagnóstico , Cistite/complicações , Cistite/tratamento farmacológico , Cistite/fisiopatologia , Diagnóstico Diferencial , Transtornos Neurológicos da Marcha/etiologia , Glucocorticoides/uso terapêutico , Antagonistas não Sedativos dos Receptores H1 da Histamina/uso terapêutico , Humanos , Síndrome Hipereosinofílica/complicações , Síndrome Hipereosinofílica/tratamento farmacológico , Síndrome Hipereosinofílica/fisiopatologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Recuperação de Função Fisiológica , Fatores de Tempo , Resultado do Tratamento , MicçãoRESUMO
BACKGROUND: Observational studies generate information on real-world therapy and complement data from prospective randomized trials. LEAN is an open-label, non-interventional, multi-centre, German cohort study on leuprorelin in routine clinical practice. OBJECTIVES: To extend knowledge on the use, effectiveness, and tolerability of HEXAL/Sandoz leuprorelin (in this article, the term Leuprone® HEXAL® covers Leuprorelin Sandoz® as well) solid implant in patients with prostate cancer (PCa) in a real-world setting. METHODS: 959 PCa patients scheduled for androgen deprivation therapy (ADT) received leuprorelin acetate implant. Metabolism, serum prostate-specific antigen (PSA), and testosterone data, if available, were collected at baseline and follow-up visits for ≥12 months. RESULTS: Of 694 patients in the modified full analysis set, 26.4% received GnRH analogues ≤6 months before enrolment. Fifty-one percent of patients were treated for locally advanced or metastatic PCa. In 19.6% of patients, ADT was used in neoadjuvant or adjuvant settings and in 28.5% with rising PSA after definite therapy. Testosterone levels <0.5 ng/mL were achieved in >90% of patients. Safety profile was in line with the summary of product characteristics. Therapy was well tolerated, with patient-triggered therapy discontinuation in 3.6%. CONCLUSIONS: This interim analysis confirmed previous efficacy findings for leuprorelin implant in a real-world setting. This contemporary cohort showed a shift in the use of ADT to non-metastatic PCa stages.
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Antagonistas de Androgênios/uso terapêutico , Antineoplásicos Hormonais/uso terapêutico , Leuprolida/uso terapêutico , Neoplasias da Próstata/sangue , Neoplasias da Próstata/tratamento farmacológico , Testosterona/sangue , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Alemanha , Humanos , Masculino , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND: Follow-up recommendations for patients with nonmuscle invasive bladder cancer (NMIBC) are largely based upon expert opinion. A growing body of evidence suggests that current follow-up strategies for bladder cancer patients with low and intermediate risk represent overdiagnosis and may lead to overtreatment. The goal of this study is to explore the options of a noninvasive follow-up in patients with pTa G1-2/low-grade NMIBC. METHODS: The risks and options for a urine marker-guided, noninvasive follow-up of patients with pTa G1-2/low-grade NMIBC were defined and the study design for a prospective randomized trial (UroFollow) was developed based upon the current literature. RESULTS: The investigators postulated that follow-up of patients with pTa G1-2/low-grade NMIBC requires a high sensitivity of urinary tumor markers. However, data from prospective studies with prediagnostic urine samples are scarce, even for approved markers, and cross-sectional studies with symptomatic patients overestimate the sensitivity. So far, cell-based markers (e.g., uCyt+ and UroVysion) in urine appeared to have higher sensitivities and specificities in low-grade NMIBC than urine cytology and markers analyzing soluble tumor-associated antigens. Marker panels are more sensitive than single-marker approaches at the expense of a lower specificity. Given a prospective randomized comparison with a marker sensitivity of 80% compared to usual care with cystoscopy, the sample size calculation yielded that 62 to 185 patients under study per arm are needed depending on different recurrence rates. CONCLUSIONS: Based upon these findings the UroFollow trial has been designed as a prospective randomized study comparing a noninvasive marker-based (UroVysion, NMP22, urine cytology, and ultrasound) follow-up with the current standard of care over a period of 3 years.
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Neoplasias da Bexiga Urinária/diagnóstico , Neoplasias da Bexiga Urinária/terapia , Biomarcadores/análise , Humanos , Invasividade Neoplásica , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Medição de Risco , Neoplasias da Bexiga Urinária/patologiaRESUMO
The 16th Meeting of the International Bladder Cancer Network (IBCN) took place from October 11 to 13, 2018 in Rotterdam, the Netherlands. As in the previous year, muscle-invasive bladder cancer (MIBC) was the main topic of the congress based upon the rapid evolution in this field over the last several years. This year´s meeting was dominated by presentations focusing on genomic subtyping in MIBC and identification of novel therapeutic targets. These topics were complemented by submissions on immunotherapy, a variety of clinical topics, and biomarker research. Based upon the presentations, it may be concluded that the IBCN increasingly serves as an interdisciplinary forum not only for the presentation of work-in-progress covering all facets of bladder cancer research, but also for catalyzing the discussion of discrepant research findings in an effort to find consensus. The 16th Meeting of the IBCN took place from October 11 to 13th, 2018 in Rotterdam, the Netherlands, hosted by Ellen Zwarthoff and Joost Boormans. Approximately 120 participants gathered for another fully packed program displaying recent achievements in basic and clinical research covering the entire spectrum of bladder cancer. This year's meeting was dominated by presentations focusing on genomic subtyping and identification of novel therapeutic targets. These topics were complemented by submissions on immunotherapy, clinical topics, and biomarker research. Keynote lectures were delivered by G. Robertson (Canada) on MIBC genomics and the organizational challenges of the PanCancerAtlas project. Comprehensive information was provided on the Cancer Genome Atlas (TCGA) project including the structure of the consortium and the development and validation of molecular classification of MIBC. Results from the project suggest that regulons (groups of genes controlled by a common regulator) appear to be correlated with prognosis and may replace gene expression analysis in the future. M. Thelen (Switzerland) discussed the role of chemokines in cancer metastasization reporting on his research on the atypical chemokine receptor 3. The inaugural IBCN lecture was presented by M. Ingersoll (France) discussing gender disparities in development of adaptive immunity following Bacillus Calmette-Guerin therapy. In addition to the traditional "Industry meets IBCN" sessions, a format for discussion between industry representatives, researchers, and physicians in break-out groups, new formats were introduced-in the Oxford style of debate, P.J. Goebell (Germany) and W. Stadler (USA) delivered animated discussion on the appropriateness of urologists administering systemic immune checkpoint inhibitors. There was consensus that practice may differ between different health systems and countries, and educational/training background. In a second interesting discussion, D. McConkey (USA) and H. Al-Ahmadie (USA) debated if traditional histology will be replaced by molecular classification of bladder tumors. It was concluded that molecular classification offers valuable additional information but cannot yet replace traditional histology. Furthermore, the growing evidence of tumor heterogeneity in bladder cancer was discussed in a separate topic session. L. Dyrskjot discussed genomic and transcriptomic heterogeneity and their impact on clinical decision making. G. Sjödahl presented data on heterogeneity of molecular subtypes within the primary tumor and between the primary tumor and metastases, that is surprisingly limited. Y. Allory discussed spatial and temporal heterogeneity of bladder cancers particularly focusing on the basal-like phenotype. Due to the continued increase in the number of participants and abstract submissions, a poster session was implemented at this year´s meeting for the first time. Posters were briefly presented in the forum. Two travel awards were presented to H. Yamashita (USA) for his submission on peroxisome proliferator-activated receptor gamma-mediated repression of transcription factor activating protein 2 alfa expression identifying a transcriptional circuit in basal-squamous bladder cancer in a cell line model. S.B. Williams (USA) received his award for his registry-based analysis of outcome and costs in patients with localized MIBC undergoing either bladder sparing trimodal therapy or radical cystectomy. The latter was found to generate improved survival outcomes at lower costs as compared with trimodal therapy. The best presentation awards were presented to A. Kamoun (France) who discussed a consensus molecular classification for MIBC. The international demand for a consensus classification, already raised at previous meetings, has resonated with important players in this field. A potential consensus comprising 6 classes was proposed based upon a thorough analysis of the existing classifications. As an extension of the IBCN meeting a consensus conference on genomic classification of MIBC was held that included all major groups in this field. M. Garige (USA) received his award for a detailed examination of inhibitors of metabolic processes in bladder cancer cells before and after therapy. A take home message of the meeting was that the IBCN increasingly serves as an interdisciplinary forum not for the presentation of work-in-progress covering all facets of bladder cancer research, but also for catalyzing the discussion of discrepant research findings in an effort to find consensus. Exemplified may this also be by the fact that the efforts to unify the subclassification of MIBC had its nidus on the preceding meetings of the IBCN on this topic and brought together the various disciplines which ultimately were able to finalize their consensus work in a last concluding meeting directly following the IBCN. Thus, the IBCN meetings and the close cooperation of IBCN with its official journal, Urological Oncology, continue to provide a unique platform for exchange, discussing and intensifying multidimensional collaborations, thus finally satisfying the increasing need for answers regarding the management of bladder cancer patients. The 17th meeting of the IBCN will take place in Aarhus, Denmark, October 3 to 5, 2019.
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Pesquisa Biomédica , Neoplasias da Bexiga Urinária/diagnóstico , Neoplasias da Bexiga Urinária/terapia , HumanosRESUMO
This editorial highlights submissions to part II of the 3rd IBCN Seminars Series particularly focusing on the tools required for conduction of translational research in bladder cancer. One of the submissions describe the ex vivo culture of primary tumor cells from N-methyl-N-nitrosourea-induced bladder tumors in rats and subsequent establishment of an immortalized cell line. In a next step the authors thoroughly characterize this cell line. They conclude that differentiation marker expression patterns observed in the original tumors are largely retained in the spheroids. Although new cancer models, such as organoid tissue cultures, hold great promise for studying cancer progression and might have a potential for development and selection of an optimal treatment, their limitations must be kept in mind. The second submission, therefore, critically questions the current role of organoid tissue culture as a predictive tool in urothelial cancer patients. The third manuscript of this series provides a broader overview of post-translational modification in bladder cancer is presented and how PTMs can be exploited as potential therapeutic targets. The 3 manuscripts featured in this issue demonstrate especially how basic research is being channeled to inform clinically actionable discoveries.
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Pesquisa Translacional Biomédica , Neoplasias da Bexiga Urinária , Animais , Linhagem Celular Tumoral , Modelos Animais de Doenças , HumanosAssuntos
Pesquisa Biomédica , Neoplasias da Bexiga Urinária , Animais , Biomarcadores Tumorais/genética , Biomarcadores Tumorais/metabolismo , Congressos como Assunto , Cistectomia , Humanos , Prognóstico , Neoplasias da Bexiga Urinária/genética , Neoplasias da Bexiga Urinária/patologia , Neoplasias da Bexiga Urinária/terapiaRESUMO
BACKGROUND: Low specificity of prostate-specific antigen results in a considerable number of unnecessary prostate biopsies in current practice. SelectMDx® predicts significant prostate cancer upon biopsy and is used to reduce the number of unnecessary initial prostate biopsies. Furthermore, potential overtreatment of insignificant prostate cancer can be reduced. Besides the diagnostic accuracy of the test, also the context in a specific country determines the potential health benefit and cost-effectiveness. Therefore, the health benefit and cost-effectiveness of SelectMDx were assessed in France, Germany, Italy, and Spain. SUBJECT AND METHODS: A decision model was used to compare the current standard of care in which men undergo initial prostate biopsy in case of an elevated prostate-specific antigen, to a strategy in which SelectMDx was used to select men for biopsy. Model inputs most relevant to each of the four countries were obtained. With use of the model long-term quality-adjusted life years (QALYs) and healthcare costs were calculated for both strategies. RESULTS: In all four countries, the SelectMDx resulted in QALY gain and cost savings compared with the current standard of care. In France, SelectMDx resulted in 0.022 QALYs gained and cost savings of 1217 per patient. For Germany, the model showed a QALY gain of 0.016 and a cost saving of 442. In Italy, the QALY gain and cost savings were 0.031 and 762. In Spain 0.020 QALYs were gained and 250 costs were saved. CONCLUSIONS: The results of the model showed that with SelectMDx, QALYs could be gained while saving healthcare costs in the initial diagnosis of prostate cancer. The significant presence of overtreatment in the current standard of care in all four countries was the main factor that resulted in the beneficial outcomes with SelectMDx.
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Biópsia/economia , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/epidemiologia , Biomarcadores Tumorais , Biópsia/métodos , Tomada de Decisão Clínica , Análise Custo-Benefício , Árvores de Decisões , Europa (Continente)/epidemiologia , França , Alemanha , Humanos , Itália , Masculino , Modelos Estatísticos , Neoplasias da Próstata/mortalidade , Neoplasias da Próstata/terapia , Vigilância em Saúde Pública , Qualidade de Vida , Anos de Vida Ajustados por Qualidade de Vida , Sensibilidade e Especificidade , EspanhaRESUMO
RATIONALE: Several guidelines exist that address treatment of patients with nonmetastatic muscle-invasive bladder cancer (MIBC). However, most only briefly mention follow-up strategies for patients and hence the treating physician is often left to infer on what the preferred follow-up schema would be for an individual patient. Herein, we aim to synthesize recommendations for follow-up of patients with MIBC for easy reference. METHODS: A multidisciplinary MIBC expert panel from the International Bladder Cancer Network was assembled to critically assess currently available major guidelines on surveillance of MIBC patients. Recommendations for follow-up were extracted and critically evaluated. Important considerations for guideline assessment included both aspects of oncological and functional follow-up-frequency of visits, the use of different imaging modalities, the role of cytology and molecular markers, and the duration of follow-up. OUTCOME: An International Bladder Cancer Network expert consensus recommendation was constructed for the follow-up of patients with MIBC based on the currently available evidence-based data.
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Seguimentos , Neoplasias da Bexiga Urinária/terapia , Consenso , Gerenciamento Clínico , Feminino , Humanos , Masculino , Neoplasias da Bexiga Urinária/patologiaRESUMO
BACKGROUND: Hematuria can be either grossly visible (macrohematuria) or only detectable under a microscope (microhematuria). Microhematuria is often asymptomatic and has a prevalence of 4-5% in routine clinical practice. It may be due to an underlying disease of the kidneys or the urogenital tract. In this article, we provide an overview of the causes of hematuria and of the recommendations of current guidelines for its diagnostic evaluation. A risk-adapted diagnostic strategy for the evaluation of asymptomatic microhematuria (aMH) is presented. METHODS: This review is based on pertinent publications retrieved by a selective search in PubMed, as well as on guidelines from Germany and abroad. RESULTS: Hematuria has many causes, and a broad urological and nephrological differential diagnosis must be considered. In the absence of high-quality scientific evidence, the recommendations of current guidelines for the diagnostic evaluation of hematuria are not uniform; this is particularly so for aMH. Microhematuria is said to be present when urine microscopy reveals three or more erythrocytes per highpower field. The basic diagnostic evaluation consists of a thorough history and physical examination, measurement of inflammatory parameters and renal function tests, and ultrasonography of the kidneys and bladder. Patients with non-glomerular aMH who have risk factors such as smoking, advanced age, and male sex are more likely to have relevant underlying conditions and should therefore undergo augmented, risk-adapted diagnostic evaluation with urethrocystoscopy, urine cytology, and, when indicated, CT urography. Patients with isolated glomerular hematuria are at elevated risk for renal disease and should undergo follow-up checks at six-month intervals. CONCLUSION: Although hematuria is common, there is no uniform, internationally accepted, evidence-based algorithm for its diagnostic evaluation. All potential causes of hematuria must be considered, and all individual risk factors taken into account, so that an underlying disease requiring treatment can be identified or ruled out.