AUAUniversity

AUA Guidelines: Treatment Of Non - Metastatic Muscle - Invasive Bladder Cancer

Guest: Jeffrey M Holzbeierlein, MD

Outline:

Segment #1: Guideline Statement 9-Patients who have not received cisplatin-based NAC and have pT3-4 and/or N= disease at cystectomy should receive adjuvant cisplatin based chemotherapy or adjuvant immunotherapy.

Segment #2: Guideline Statement 11-When performing a cystectomy in males the bladder, prostate cand seminal vesicles should be removed (no change) but in females clinicians should consider removal of adjacent reproductive organs based on individual disease characteristics and need to obtain negative margins. Organ sparing procedures in females should be considered based on disease location and characteristics on an individual basis.

Segment #3: Guideline Statement 20-When performing bilateral pelvic lymphadenectomy , clinicians should remove, at a minimum, the external and internal iliac and obturator lymph nodes (standard lymphadenectomy).

Segment #4: Future Directions

Treatment of Non-Metastatic Muscle-Invasive Bladder Cancer: AUA/ASCO/ASTRO/SUO Guideline

Holzbeierlein J, Bixler BR, Buckley DI, et al. Treatment of non-metastatic muscle-invasive bladder cancer: AUA/ASCO/SUO guideline (2017; amended 2020, 2024). J Urol. Published online April 25, 2024. doi:10.1097/JU.0000000000003981 https://www.auajournals.org/doi/10.1097/JU.0000000000003981

Biomarkers and Molecular Imaging for Prostate Cancer

CME Available: auau.auanet.org/node/41727

ACKNOWLEDGEMENTS:

Support provided by independent educational grants from:

Lantheus Medical Imaging

Novartis Pharmaceuticals Corporation

LEARNING OBJECTIVES:

At the conclusion of this activity, participants will be able to:

1. Explain the principles of molecular imaging and its application in prostate cancer, including techniques such as PET, MRI, and novel radiotracers.

2. Evaluate recent advances in molecular imaging technologies and their role in improving the accuracy of prostate cancer diagnosis, staging, and treatment monitoring.

3. Define and classify different types of biomarkers relevant to prostate cancer, including diagnostic, prognostic, and predictive biomarkers.

Appropriate Use of Genetic Testing (who, what, when and how?)

CME Available: auau.auanet.org/node/41734

ACKNOWLEDGEMENTS:

Support provided by independent educational grants from:

Lantheus Medical Imaging

Novartis Pharmaceuticals Corporation

LEARNING OBJECTIVES:

At the conclusion of this activity, participants will be able to:

1. Identify the patient populations that should be considered for genetic testing in prostate cancer, based on family history, personal risk factors, and clinical indications.

2. Integrate genetic testing into clinical practice for prostate cancer, including developing workflows, referral processes, and multidisciplinary collaboration.

3. Utilize genetic test results to inform personalized treatment plans for prostate cancer patients, including targeted therapies and risk reducing strategies.

Treatment Intensification in Metastatic HSPC

CME Available: https://auau.auanet.org/node/41733

ACKNOWLEDGEMENTS:

Support provided by independent educational grants from: 

Lantheus Medical Imaging

Novartis Pharmaceuticals Corporation

LEARNING OBJECTIVES:

At the conclusion of this activity, participants will be able to:

1. Explain the rationale behind treatment intensification in metastatic hormone sensitive prostate cancer (mHSPC), based on its pathophysiology. 

2. Analyze the rationale and clinical evidence supporting treatment intensification in mHSPC, including potential benefits and risks. 

3. Select appropriate patients for treatment intensification, considering factors such as disease burden, patient comorbidities, and individual risk profiles.

Sequencing Of Agents

CME Available: auau.auanet.org/node/41735

ACKNOWLEDGEMENTS:

Support provided by independent educational grants from:

Lantheus Medical Imaging

Novartis Pharmaceuticals Corporation

LEARNING OBJECTIVES:

At the conclusion of this activity, participants will be able to:

1. Review the latest evidence and clinical guidelines that inform the sequencing of therapeutic agents in metastatic prostate cancer, including data from key clinical trials.

3. Implement strategies for managing and overcoming resistance to therapy in metastatic prostate cancer, considering the role of sequencing in delaying resistance.

4. Apply best practices for monitoring treatment response and disease progression in patients undergoing therapy, and adjust sequencing strategies based on these observations.

Non-Muscle Invasive Bladder Cancer: Expert Guidance for Urologists

CME Available: https://auau.auanet.org/node/41961

After participating in this CME activity, participants will be able to:

1. Assess the risk stratification of low, intermediate, and high risk NMIBC patients to appropriately guide treatment decisions.

2. Employ diagnostic techniques for NMIBC, including cystoscopy, urine cytology, biomarkers, and advanced imaging modalities.

3. Tailor treatment strategies based on individual patient characteristics and tumor biology to highlight the potential of personalized medicine in improving the management of NMIBC.

4. Identify new and emerging therapies for NMIBC, such as novel intravesical agents and immunotherapies.

5. Properly manage adverse events associated with NMIBC treatment.

Acknowledgements

Support provided by an independent educational grant from:

ImmunityBio, Inc.

Merck & Co., Inc.

UroGen Pharma, Inc.

Contemporary Management of MIBC and Beyond: Expert Guidance for Urologists

CME Available: https://auau.auanet.org/node/42040

After participating in this CME activity, participants will be able to:

1. Describe the multimodal treatment approach for MIBC, including surgery, radiation therapy, and chemotherapy.

2. Analyze the role of neoadjuvant and adjuvant therapies, including chemotherapy, immunotherapy, and antibody drug conjugates, in improving patient outcomes.

3. Utilize knowledge of checkpoint inhibitors and antibody drug conjugates with their mechanisms of action to interpret the role of immunotherapy in the treatment of metastatic urothelial carcinoma.

4. Examine ongoing clinical trials and emerging treatments that are shaping the future of metastatic urothelial carcinoma management.

5. Employ appropriate patient and family education strategies regarding MIBC and metastatic urothelial carcinoma, treatment options, and expected outcomes.

Acknowledgements

Support provided by an independent educational grant from:

Astellas and Pfizer, Inc.

Complex Cases in Kidney Stone Disease

CME Available: https://auau.auanet.org/node/41889

At the conclusion of this activity, participants will be able to:

1. Describe the pathophysiology, genetic basis, and clinical presentation of Primary Hyperoxaluria Type 1.

2. Analyze the unique considerations and challenges in evaluating kidney stones in pediatric patients.

3. Utilize the results of 24-hour urine testing to guide dietary and pharmacologic interventions for stone prevention.

4. Recognize the indications for genetic testing in patients with kidney stones and utilize the results to inform diagnosis and treatment.

5. Employ appropriate patient management and family counseling strategies in consideration of the impact of genetic testing results.

6. Properly refer patients with kidney stone disease to a nephrologist when warranted.

ACKNOWLEDGEMENTS:

Support provided by an independent educational grant from: 

Alnylam Pharmaceuticals, Inc.

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AUA2024: Journal of Urology Lecture: Empowering Communities: Fostering Prostate Cancer Awareness and Resilience Among Men of Color

Presenter: Quoc-Dien Trinh, MD, MBA