Treatment of Non-Metastatic Muscle-Invasive Bladder Cancer

1. Prior to treatment consideration, a full history and physical exam should be performed, including an exam under anesthesia at the time of transurethral resection of bladder tumor (TURBT) for a suspected invasive cancer. (Clinical Principle, )

2. Prior to muscle-invasive bladder cancer (MIBC) management, clinicians should perform a complete staging evaluation, including imaging of the chest and cross sectional imaging of the abdomen and pelvis with intravenous contrast if not contraindicated. Laboratory evaluation should include a comprehensive metabolic panel (complete blood count, liver function tests, alkaline phosphatase and renal function). (Clinical Principle, )

3. An experienced genitourinary pathologist should review the pathology of a patient when variant histology is suspected or if muscle invasion is equivocal (e.g., micropapillary, nested, plasmacytoid, neuroendocrine, sarcomatoid, extensive squamous or glandular differentiation). (Clinical Principle, )

4. For patients with newly diagnosed MIBC, curative treatment options should be discussed before determining a plan of therapy that is based on both patient comorbidity and tumor characteristics. Patient evaluation should be completed using a multidisciplinary approach. (Clinical Principle, )

5. Prior to treatment, clinicians should counsel patients regarding complications and the implications of treatment on quality of life (e.g., impact on continence, sexual function, fertility, bowel dysfunction, metabolic problems). (Clinical Principle, )