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To evaluate the utility of renal mass biopsy (RMB) in shared decision-making for renal mass treatment. Underutilization of RMB for patients with renal masses is due in part to physicians believing that results have limited clinical utility. This was a prospective study of all patients referred for RMB from October 2019 to October 2021. Patients and physicians completed pre- and post-RMB questionnaires. Questionnaires assessed both parties' perceived utility of RMB and the impact of biopsy results on treatment preference using Likert scales. We enrolled 22 patients with a mean age of 66 years (SD 14.5) and mean renal tumor size 3.1 cm (SD 1.4). Five were lost to follow-up (three pre-RMB, two post-RMB). Pre-RMB, 100% of patients believed that a biopsy would help them choose a treatment and 45% were unsure of their treatment preferences. After RMB, 92% perceived their biopsy results as useful and only 9% were unsure of treatment preference. Overall, 100% of patients were glad they had a biopsy. Results led patients and physicians to change their treatment preference in 57% and 40% of cases, respectively. Patients and physicians disagreed about treatment in 81% of cases prior to biopsy, but in only 25% of cases after biopsy. Discordance between patient and physician treatment preference for renal masses is higher in the absence of RMB data. Select patients are willing to undergo RMB and RMB data can increase patient confidence and comfort in a shared decision-making approach for renal mass treatment. [Display omitted] [ABSTRACT FROM AUTHOR]

Bacillus Calmette-Guerin (BCG) is a live attenuated Mycobacterium bovis strain, originally developed as a vaccine against tuberculosis. It is also the only bacterial cancer therapy approved by the US Food & Drug Administration for clinical use. BCG is delivered in the bladder, shortly after tumour resection, for patients with high-risk non-muscle invasive bladder cancer (NMIBC). Modulating mucosal immunity by exposing the urothelium to intravesical BCG has been the main therapeutic strategy for high-risk NMIBC over the last three decades. Thus, BCG provides a benchmark for the clinical development of bacteria—or other live attenuated pathogens—as cancer therapy. Currently, a myriad of immuno-oncology compounds is under clinical evaluation in BCG-unresponsive and BCG-naïve patients as an alternative therapy in the context of worldwide BCG shortages. For patients with non-metastatic muscle-invasive bladder cancer (MIBC), studies investigating neoadjuvant immunotherapy with either anti–PD-1/PD-L1 monoclonal antibodies in monotherapy or in combination with anti–CTLA-4 monoclonal antibodies have shown overall efficacy and acceptable safety profiles prior to radical cystectomy. Emerging clinical investigations are testing synergistic approaches by combining intravesical delivery of drugs with systemic immune checkpoint blockades in the neoadjuvant setting for patients with MIBC. Such novel strategy aims to prime a local anti-tumour immunity and reduce distant metastatic relapses by enhancing a systemic adaptive anti-tumour immune response. Here, we present and discuss some of the most promising clinical trials developing such novel therapeutic approaches. • Multiple IO drugs target mucosal immunity in bladder cancer. • Intravesical delivery of IO drugs appears to be a safe and efficient therapy. • Several IO drugs could be an alternative to BCG therapy in the near future. • Neoadjuvant intravesical IO drugs with systemic ICB may change the standard of care for patients with MIBC. [ABSTRACT FROM AUTHOR]

• The Natural history of Prostatic Urethra recurrences after BCG Induction has not been well described in the literature. • Patients with Prostatic Urethra recurrences have a high-risk disease phenotype. • Radical Cystoprostatectomy is often first line treatment for these patients. • Conservative management may be appropriate for well-selected patients who do not desire a cystoprostatectomy. To describe the incidence and management of patients who develop a prostatic urethral (PU) urothelial carcinoma recurrence after Bacillus Calmette-Guerin (BCG) induction for non-muscle invasive bladder cancer (NMIBC). We performed a retrospective cohort study of all patients who received BCG induction at our institution from 1996 to 2021 (N = 642) for NMIBC. All patients with pathologically confirmed PU involvement following BCG induction with no known PU involvement pre-BCG were included. We describe the presentation, management, and outcomes for PU recurrence. Among the 642 patients, 21 (3.3%) patients had a PU recurrence after BCG induction. 8 (38%) patients received >2 cycles of BCG induction prior to the recurrence. Median time from induction to PU recurrence was 21 months and 12 (57.1%) patients had concurrent bladder recurrence. At the time of their PU recurrence, 14/21 (67%) of patients were deemed BCG Unresponsive. Nearly all (18/21) were high grade, and 10 were stage Tis, 7 Ta, and 3 T1, and 1 T2. 19/21 (90%) patients received bladder sparing treatment: 6 with TURBT and BCG, 6 with TURBT and intravesical chemotherapy, 5 with TURBT only, and 2 did not receive immediate treatment of their PU recurrence due to advanced stage of disease. 2/21 (9.5%) received a radical cystectomy for initial treatment of the post-BCG PU recurrence, of which all were >pT2. Median follow-up time from BCG induction to the patient's last visit was 64.5 months. Following treatment of PU recurrence, 15/18 patients had another recurrence at a median of 5 months: about 47% of recurrences were bladder only and 14% recurred only in the PU as well. About 1 patient received a RC after the second recurrence and was pT2. Patients with PU recurrences following intravesical BCG have a high-risk disease phenotype with a significant risk of recurrence. Conservative management may be appropriate for well-selected patients who do not desire a cystoprostatectomy. [ABSTRACT FROM AUTHOR]

• Among patients with clinically organ-confined MIBC, PC appears to afford similar survival outcomes to RC in a large national data set. • Partial cystectomy can be considered in carefully selected patients (cT2, cN0, tumor size ≤5 cm, and no concurrent carcinoma in situ (CIS). While radical cystectomy (RC) is the standard of care for muscle invasive bladder cancer (MIBC), partial cystectomy (PC) is an effective alternative in select patients. We sought to examine differences in survival for RC and PC in a hospital-based registry. We identified patients diagnosed with cT2−4 bladder cancer who underwent RC or PC from 2003 to 2015 in the National Cancer Database (NCDB). Using inverse probability treatment weighting (IPTW) to control for known confounders, we compared the primary outcome of overall survival (OS) in patients who underwent RC vs. PC. Kaplan-Meier survival analysis, univariable and multivariable Cox proportional hazards modeling were used. We performed a secondary survival analysis for a subcohort of patients with cT2, cN0, tumor size ≤5 cm, and no concurrent carcinoma in situ (CIS), who may be optimal candidates for PC. A total of 22,534 patients met inclusion criteria, of which 6.9% (1,457) underwent PC. RC had longer median OS than PC (67.8 vs. 54.1 months) and on Cox regression analysis (HR 0.88, 95% CI, 0.80–0.95, P = 0.002). However, in our subcohort, there was no difference in OS between RC and PC (HR 1.02, 95% CI, 0.9–1.2, P = 0.74). PC was associated with increased time from surgery to any systemic therapy or death in the subcohort. Among patients with clinically organ-confined MIBC, PC appears to afford similar survival outcomes to RC in a large national data set. The safety and tolerability of PC may warrant consideration in highly selected patients. [ABSTRACT FROM AUTHOR]

Purpose: Partial cystectomy (PC) is a bladder sparing option to treat bladder cancer in a carefully selected group of patients. We sought to analyze outcomes of partial cystectomy (PC) in a contemporary cohort of patients at a single institution.Material and Methods: Records were reviewed for 43 patients with a primary urothelial carcinoma (UC) who had a partial cystectomy with curative intent at Columbia University Medical Center from 2004 to 2019. Endpoints of interest were noninvasive recurrence (defined as any recurrent nonmuscle invasive disease), advanced recurrence (defined as a muscle invasive recurrence or metastasis), and death. We used unadjusted Cox proportional hazards regressions and log rank tests to estimate the association between clinical characteristics and endpoints of interest.Results: Among 43 patients with bladder cancer treated with partial cystectomy, median patient age was 73 years (interquartile range 67-77.5) and 86% were male. Twenty-three percent of patients received preoperative neoadjuvant chemotherapy (NAC) and 49% of patients were given perioperative intravesical chemotherapy at the time of PC. Pathologic stage was Conclusions: In well-selected patients, partial cystectomy offers adequate local control of bladder cancer. The risk of systemic progression is similar to reported case series of RC. [ABSTRACT FROM AUTHOR]

For patients with muscle invasive bladder cancer (MIBC), the standard of care is platinum-based neoadjuvant chemotherapy (NAC) followed by radical cystectomy (RC). However, many patients refuse or are medically unfit for RC. Furthermore, between 20% and 30% of patients treated with NAC have no evidence of disease at RC. Therefore, patients who achieved a clinical complete response (cCR) to NAC and refused definitive treatment were placed on an active surveillance cCR protocol. Previous studies have reported on the long-term outcomes of this cohort. This study presents the incidence and management of non-muscle invasive bladder cancer (NMIBC) recurrence in patients while on cCR surveillance protocol. This was a retrospective review of a prospectively-maintained database of all patients on a cCR surveillance protocol. To enter cCR protocol, patients must have received platinum-based NAC for MIBC followed by negative cross-sectional imaging, negative cytology, and negative post-NAC maximal endoscopic resection. Patients were followed with office cystoscopy and cytology every three months and cross-sectional imaging every six months, with repeat transurethral resections (TURs) for suspicious-appearing lesions or positive cytology. Patients with MIBC recurrence or metastases within six months were deemed to be misclassified cCR and excluded from analysis. Any cCR without MIBC recurrence or metastases was considered durable, even with NMIBC recurrence. Any intravesical recurrence prompted a recommendation for definitive treatment with RC. However, patients who recurred with NMIBC and wished to continue bladder-sparing were treated, and outcomes are reported here. Outcomes of interest were number of NMIBC recurrences, grade and stage, and treatment. A total of 61 patients had cCR, of whom 14 (23%) had history of prior NMIBC. Median time in cCR protocol was 28.3 months (IQR 10.1-58.9). Overall, 49 (80%) had durable response without MIBC recurrence or metastases. In total, 28 patients (46%) experienced a median of one NMIBC recurrence (IQR 1-2, range 0-7) with 20 (33%) having one recurrence, five (8%) having two recurrences, and three (5%) having three or more recurrences. Median time to recurrence was 11.5 months (IQR 5.2-20.3). There were 46 total recurrences; nine (20%) were LGTa, 11 (24%) were HGTa, nine (20%) were HGT1, and 17 (37%) were CIS. LGTa recurrences were all treated with TUR alone. HG recurrences were treated with BCG in 22 (59%), induction chemotherapy in one (3%), TUR alone in four (11%), and cystectomy in seven (19%). Patients with NMIBC recurrences were not more likely to recur with muscle-invasive or metastatic disease. Many patients who develop a cCR after NAC for MIBC achieve a durable response without MIBC or metastatic recurrence. However, a large proportion of these patients will experience NMIBC recurrence, primarily with HG disease. The majority of these are single recurrences managed with BCG. In this small subset, it did not appear that NMIBC recurrences resulted in higher rates of subsequent MIBC or metastatic recurrences. These data are important to appropriately counsel patients that those who achieve a cCR still have a substantial risk of NMIBC recurrence and require careful surveillance. [ABSTRACT FROM AUTHOR]