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• W4210367968 abstract "We read with great interest the 2020 updated bladder cancer ESMO clinical practice guideline for diagnosis, treatment and follow up, and we commend the stellar panel of authors for their monumental work. This being said, we would like to respectfully comment on several points that in our opinion should be discussed or updated.1Powles T. Bellmunt J. Comperat E. et al.Bladder cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up.Ann Oncol. 2022; 33: 244-258Abstract Full Text Full Text PDF PubMed Scopus (45) Google Scholar First, bimanual palpation under anesthesia should no longer be considered a standard of care in the diagnoses of every locally advanced bladder cancer. Cross sectional imaging carried out before transurethral resection of the bladder (TURBT) represents the correct diagnostic pathway, where only a limited number of bladder cancer patients (suspicious T3 on cross sectional imaging2Rozanski A.T. Benson C.R. McCoy J.A. et al.Is exam under anesthesia still necessary for the staging of bladder cancer in the era of modern imaging?.Bladder Cancer. 2015; 1: 91-96Crossref PubMed Scopus (7) Google Scholar) perhaps benefit from an additional staging with bimanual palpation. Second, not only macrohematuria should be investigated. Microhematuria also needs to be taken into account. Data from the DETECT trial3Shah R.B. Montgomery J.S. Montie J.E. Kunju L.P. Variant (divergent) histologic differentiation in urothelial carcinoma is under-recognized in community practice: Impact of mandatory central pathology review at a large referral hospital.Urol Oncol. 2013; 31: 1650-1655Crossref PubMed Scopus (111) Google Scholar suggest that 3.1% of patients with microhematuria have a urinary tract cancer; in this regard, physicians should be aware that patients with microhematuria (especially those with risk factors for bladder cancer) should be investigated. Third, accurate pathology assessment is pivotal in the management of bladder cancer. In this regard, the necessity of having an expert dedicated genitourinary (GU) pathologist is fundamental, considering that diagnosis will change in ∼40%4Tan W.S. Feber A. Sarpong R. et al.Who should be investigated for haematuria? Results of a contemporary prospective observational study of 3556 patients.Eur Urol. 2018; 74: 10-14Abstract Full Text Full Text PDF PubMed Scopus (50) Google Scholar of the cases after a review by a dedicated GU pathologist. The impact of a dedicated GU pathologist is huge and every institution who wants to treat these patients with success should have one. Fourth, the authors did not mention the excellent data regarding the impact of neoadjuvant immunotherapy on pathological and survival outcomes in patients affected by pT2-4a N0 M0 bladder cancer. Whereas we agree that cisplatin-based chemotherapy still represents the standard of care and that immunotherapy needs more robust phase III trials, the excellent results achieved in phase II trials, such as for pembrolizumab in the PURE-01 trial, should be mentioned.5Necchi A. Anichini A. Raggi D. et al.Pembrolizumab as neoadjuvant therapy before radical cystectomy in patients with muscle-invasive urothelial bladder carcinoma (PURE-01): an open-label, single-arm, phase II study.J Clin Oncol. 2018; 36: 3353-3360Crossref PubMed Scopus (345) Google Scholar Finally, with regard to upper tract urinary carcinoma, the risk of bladder recurrence after treatment is well known and an early bladder instillation should be offered to patients undergoing radical nephroureterectomy with a bladder cuff.6Jung H. Giusti G. Fajkovic H. et al.Consultation on UTUC, Stockholm 2018: aspects of treatment.World J Urol. 2019; 37: 2279-2287Crossref PubMed Scopus (10) Google Scholar Moreover, we suggest that kidney-sparing strategies require a mandatory close follow-up to diagnose early local recurrence with an early second-look ureteroscopy. None declared." @default.
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• W4210367968 date "2022-05-01" @default.
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• W4210367968 title "Bladder cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up" @default.
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• W4210367968 doi "https://doi.org/10.1016/j.annonc.2022.01.075" @default.
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