Search

In the future, precision medicine with agents targeting specific genetic alterations will play an important role in bladder cancer. This includes both single genetic alterations (e.g. FGFR3) and gene panel analyses in patients with no further therapeutic options, rare cancer subtypes or unusual clinical courses. These molecular analyses can be carried out on formalin-fixed paraffin-embedded tumor samples and the results should be discussed in interdisciplinary molecular tumor boards in order to either recommend approved targeted therapies or suggest patients for molecular-based clinical trials, compassionate use programs or off-label use of drugs. The remuneration of molecular diagnostics is largely well-represented for the outpatient sector in Germany; however, the covering of treatment costs must currently be approved by the health insurances., (© 2021. Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Background: Technical advancement and availability of high-throughput analysis has advanced molecular subtyping of most cancers. Thus, new possibilities for precision oncology have emerged., Aim: Therefore, we aimed to collect data regarding availability and use of next generation sequencing (NGS) for urothelial cancer within the uropathology working group of the German Society of Pathology., Methods: We collected data by questionnaires and additionally asked for sequencing results of bladder cancers in the participating institutions., Results: A total of 13 university-affiliated institutes of pathology took part in the survey. All university institutes offer NGS-based molecular panel diagnostics and provide panels covering between 15 and 170 genes. Altogether, only 20 bladder cancers were sequenced in routine diagnostics and for 10 cancers potential targeted treatment options were available., Discussion: So far, despite availability of NGS diagnostics at university institutes of pathology, only few bladder cancer samples have been sequenced. Based on current data from the molecular subtyping of bladder cancers, we recommend a step-by-step protocol with basic immunohistochemistry analysis and subsequent subtype-dependent analyses, e.g., alterations of the fibroblast growth factor receptors (FGFR) or comprehensive gene panel analyses.

Besides evidence- and guideline-based tumor therapy, personalized targeted therapies within study settings or individual experimental settings in advanced cancers without further therapeutic options are emerging. A comprehensive molecular analysis of the tumor in a molecular pathology laboratory is important for all targeted therapy approaches. However, the interpretation of the molecular results is crucial and potential therapeutic conclusions can only be drawn by considering the clinical situation and within a setting of oncological experience. Therefore, the molecular results and their potential impact have to be discussed at a molecular tumor board, an interdisciplinary expert team consisting of clinicians, oncologists, (molecular) pathologists, systems physicians, study teams and where required geneticists. If the molecular tumor board decides a targeted therapeutic approach is appropriate, patients should be enrolled in studies or registries with controlled settings and documentation in order to evaluate the therapeutic concepts. Furthermore, molecular-based individual experimental therapies are possible within extreme clinical situations.

Introduction: Urothelial carcinoma of the bladder is known as one of most common malignant tumors in the urogenital tract. Non-muscle invasive bladder cancer (NMIBC) in particular has a high recurrence rate and results in correspondingly high costs for the public health system., Methods: To improve the recurrence rate and the prognosis of NMIBC the diagnosis, resection technique, adjuvant instillation therapy and exact histopathological classification of tumor lesions are indispensable. This article gives an overview on the current developments in this field., Results: The current European Association of Urology (EAU) guidelines and the preliminary version of the German S3 guidelines on bladder cancer list photodynamic diagnosis (PDD) and narrow band imaging (NBI) as diagnostic procedures for tumors of the bladder. The trend for resection of bladder tumors is towards the use of en bloc resection using various techniques. Furthermore, an update of the WHO classification aims at a better identification and prognosis of the different risk groups of NMIBC., Conclusion: The treatment of NMIBC can only be improved by the combination of optimized diagnosis, precise tumor resection, improved adjuvant intravesical therapy and correct histopathological evaluation of tumors.

The current 2004 WHO classification of bladder tumors categorizes non-invasive and invasive urothelial neoplasms into prognostically relevant groups according to the histopathological cell morphology and underlying genetic changes. Although many parts of the classification have not been changed dramatically, even small changes have caused uncertainty and scepticism among urologists and pathologists in recent years. The following review article is structured into various challenges for urologists and pathologists and provides an overview of rare but clinically relevant subgroups and diagnostics, interpretation of diagnoses and pathological findings with respect to consequences for the daily clinical routine (extended diagnosis, therapy and prognosis).

Patient care with noninvasive or minimally invasive methods is appealing for the patient. It has to be assessed in terms of validity to guarantee improvement of patient care. Urine cytology for the detection of tumour cells can be considered a valid method since its specificity and sensitivity is high when high-grade tumour cells are sought. High-grade tumour cells are considered the clinically most relevant finding in urine specimens. Fluorescent in situ hybridization of interphase nuclei on centromeric and gene loci has been optimized for urothelial carcinoma and increases the sensitivity of tumour findings. It also gives a valid chance to adapt the number of cystoscopies in the follow-up of bladder cancer patients more individually.

Background: Bowen's disease and erythroplasia of Queyrat are intraepidermal neoplasias (carcinoma in situ) and are considered as preinvasive types of penile squamous cell carcinoma. The risk of progression to invasive cancer is low and such a process can last up to 20 years., Material and Method: Penis preservation and simultaneous complete excision of the tumour are strongly related to the quality of life of the patients and thereby represent the aim of the therapy. Local excision with reconstructive plastic surgery allows satisfactory aesthetic results without jeopardizing cancer control., Results: The results of this treatment are comparable with those after Nd-YAG laser therapy. Local recurrence occurs in up to 33% also after years irrespective of the surgical strategy chosen., Conclusion: A close follow-up with timely treatment of recurrences allows suitable tumour control without worsening the prognosis and is the most important requirement for an organ-preserving treatment of Bowen's disease.