Two Onc Docs Uromigos x Localized Bladder Cancer 2023 UPDATE
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Dec 11, 2023 
Dr. Tom Powles and Dr. Brian Rini discuss 2023 updates for localized bladder cancer, including diagnostic workup, staging, and treatment options. They share mixed opinions on a trial and challenges in therapy, express skepticism towards PET scans, and explore various treatment options. Exciting insights from the urologic oncology experts!
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Variant Histology Is Underrecognized
- Variant histologies in bladder cancer are under-reviewed and can be misclassified frequently.
- Central pathology review showed only ~50% concordance with local reads, affecting treatment decisions.
Always Confirm Muscle In Specimen
- Repeat a TURBT if the specimen lacks muscle to confirm staging.
- Treat initial office cystoscopy as a diagnostic step and plan full resection under anesthesia when needed.
Treat High‑Risk NMIBC Aggressively
- For high-risk non‑muscle invasive disease, give six weekly BCG followed by maintenance up to three years after CR.
- For BCG-unresponsive disease, use intravesical chemo or systemic pembrolizumab for CIS per KEYNOTE-057.