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World Journal of Urology
Erschienen in:

27.01.2022 | Invited Review

Adjuvant therapies for non-muscle-invasive bladder cancer: advances during BCG shortage

verfasst von: Adithya Balasubramanian, Ashray Gunjur, Andrew Weickhardt, Nathan Papa, Damien Bolton, Nathan Lawrentschuk, Marlon Perera

Erschienen in: World Journal of Urology | Ausgabe 5/2022

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Abstract

Non-muscle-invasive bladder cancer (NMIBC) represents a significant global therapeutic challenge, particularly in the era of Bacillus Calmette–Guérin (BCG) shortage. High-risk NMIBC can progress to muscle invasive or metastatic disease in 25% of patients. Optimal treatment selection, according to risk stratification, is imperative. International guidelines slightly differ in their categorisation of low, intermediate and high-risk NMIBC. Nonetheless, a single post-operative instillation of chemotherapy with Mitomycin C (MMC) or Gemcitabine improves relapse-free survival (RFS) in low-risk NMIBC. Induction and maintenance intravesical BCG remains the historical gold standard for patients with intermediate or high-risk NMIBC. However, clinicians may be forced to consider alternatives given the current BCG shortage. Both intravesical MMC and Gemcitabine have been associated with similar efficacy to BCG, albeit in smaller studies. MMC may also be manipulated using a variety of methods to potentiate its effects. BCG treatment delivery may also be modified without affecting efficacy through dose reduction and abbreviation or omission of maintenance therapy. Preliminary data also highlight that directly proceeding to radical cystectomy may not adversely affect long-term quality of life measures. Access to new systemic and intravesical therapies must be prioritised for patients with BCG recurrent or unresponsive disease. When used in conjunction with molecularly defined biomarkers, these agents herald the potential for improved survival outcomes and alleviation of the current BCG shortage.
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Metadaten
Titel
Adjuvant therapies for non-muscle-invasive bladder cancer: advances during BCG shortage
verfasst von
Adithya Balasubramanian
Ashray Gunjur
Andrew Weickhardt
Nathan Papa
Damien Bolton
Nathan Lawrentschuk
Marlon Perera
Publikationsdatum
27.01.2022
Verlag
Springer Berlin Heidelberg
Erschienen in
World Journal of Urology / Ausgabe 5/2022
Print ISSN: 0724-4983
Elektronische ISSN: 1433-8726
DOI
https://doi.org/10.1007/s00345-021-03908-x

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Explainable artificial intelligence (XAI): closing the gap between image analysis and navigation in complex invasive diagnostic procedures

  • Invited Review

Can artificial intelligence help reduce unnecessary bladder biopsies? Comment on “Assessing treatment response after intravesical bacillus Calmette–Guerin induction cycle: are routine bladder biopsies necessary”

  • Letter to the Editor

Neu im Fachgebiet Urologie

Nierenzellkarzinom: Kein Nachteil durch subkutan appliziertes Nivolumab

Die subkutane Applikation von Nivolumab ist nach Daten einer Phase-3-Studie ähnlich gut wirksam wie die intravenöse: Die Pharmakokinetik ist vergleichbar, die objektive Response war in der Studie sogar leicht besser als in der Gruppe mit Infusionen.

Auf weichem Fahrradsattel ist nicht gut Kinder zeugen

Männer, die sich gern sportlich verausgaben, riskieren möglicherweise, fürs Vaterwerden nicht genug Kräfte übrig zu haben. In einer Studie fanden sich dafür zwar allenfalls schwache Anzeichen. Es gab jedoch eine Ausnahme.

Vorteile für Androgenentzug plus Androgenrezeptorblockade

Für Männer mit metastasiertem hormonsensitivem Prostata-Ca. (mHSPC), die keine Hormonchemotherapie wollen oder vertragen, ist der Androgenentzug plus Darolutamid eine Alternative: Das Progressionsrisiko wird im Vergleich zum alleinigen Androgenentzug fast halbiert.

Bei „Harnwegsinfekt“ mit Fieber an akute Prostatitis denken!

Symptome eines Harnwegsinfekts sind bei geriatrischen Patienten keinesfalls auf die leichte Schulter zu nehmen. Der Urogeriater Prof. Andreas Wiedemann von der Uni Witten/Herdecke warnt vor zwei schweren Krankheitsbildern, die immer noch häufig übersehen werden, und gibt praktische Tipps für die Diagnostik.

Update Urologie

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