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Interview with Prof. Arnaulf Stenzl at EAU 2017 - New approach for treatment of non muscle invasive bladder cancer (NMIBC)
Professor Arnaulf Stenzl MD
Chairman, EAU Congress Committee
Professor and Head of Department of Urology
Eberhard-Karls University, Tubingen, Germany
For the non-muscle invasive bladder cancer which is the most common form of bladder cancer in the US, either cancer, it is usually treated with less care than it actually should need. The reason for that is because it is very frequent, it's not such a long and not such a heavy or difficult operation, but we have seen that the more or the better you treat, urothelial cancer, non-muscle invasive, sometimes non-invasive at all, the better the outcome in the long term for some patients. Not for all of them, but for some patients, if you are treating a urothelial tumour by, for example, unblock resection with using all the recommendations for any urological operation, then these patients or some of those patients may have a better fate in the long term outcome, not only because they will have long intervals for recurrence, which is a very frequent thing, but they will also have a better outcome with regards to progression and sometimes even survival. Not all patients, but some of them.
So, we should really try with all our possibilities to try to get a perfect primary resection of a urothelial cancer because we then may have, in some patients, a better outcome, not only with regards to recurrence, but also with regards to progression.
The possibilities which we have: unblock resection, the sterilisation of possible floating cells during or after the resection, that is any adjuvant installation therapy, and other possibilities should be applied.
The take-home message is get a perfect trans-urethral resection at the beginning. It is an intervention, it is a surgical intervention, you may not say it's surgery, but it's a surgical intervention and it does have an impact for some patients in the long term, not only to show that they are free of tumour for the next three, six, nine months, but that they had a perfect resection with regards to less billing, better removal and possible removal of non-visible tumour cells with the naked eye in a white light cystoscopy.
Non-muscle invasive bladder cancer (NMIBC) is a common form of bladder and urothelial cancer is usually treated with less care than it should be. A new approach to this frequent condition is to have a perfect primary resection using techniques such as en bloc resection (EBR) and “sterilization” of floating cells during or after resection with adjuvant instillation therapy. In this video, Prof. Stenzl summarizes the benefits of transurethral EBR as a surgical intervention for NMIBC versus the standard surgical procedures in terms of better patient outcomes in the long term.