Exploring the Need for a Consensus Guideline for the Management of Non-Muscle-Invasive Bladder Cancer: A Scoping Review

TL;DR

This review highlights the lack of standardized guidelines for managing non-muscle-invasive bladder cancer and suggests the need for harmonized protocols and innovative therapies.

Contribution

The study identifies gaps in current management practices and emphasizes the need for consensus guidelines and collaborative research in non-muscle-invasive bladder cancer.

Findings

Substantial differences exist in clinical practices for managing non-muscle-invasive bladder cancer.

Newer therapies like immune checkpoint inhibitors show promise but are not widely adopted.

Standardized therapy protocols and patient-centered approaches are lacking in current management.

Abstract

Non-muscle-invasive bladder cancers (NMIBC) are a heterogeneous subclass of bladder cancers consisting of carcinoma in situ, stage Ta disease, and stage T1 disease. Despite treatment by tumor resection, they have a high rate of recurrence and progression, which present unique management challenges. This scoping review discusses the management of NMIBC, including risk stratification, intravesical therapy, surveillance protocols, and developing treatments. A systematic search in different databases (PubMed/MEDLINE, Embase, Cochrane Library, and Web of Science) was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Publications in English, from January 2010 to April 2025, were included. The final search was conducted on May 5, 2025. A total of 16 studies that met our inclusion criteria were reviewed.

Different themes emerged, which include risk stratification and diagnosis, tumor resection, intravesical therapy, surveillance and follow-up, patient factors, and novel therapies. Substantial differences were found in clinical practice. Immediate postoperative chemotherapy was not adequately used, and the schedules of surveillance varied. Newer therapies, such as immune checkpoint inhibitors and novel intravesical agents, are promising. The role of enhanced cystoscopy and urinary biomarkers is also increasing for non-invasive disease monitoring. Despite this advancement, therapy standardization or a patient-centered view is still lacking. This review highlights the need for harmonized guidelines, wider access to innovative therapies, and collaborative research to improve outcomes in patients living with NMIBC.

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