The accuracy of cystoscopy in predicting muscle invasion in newly diagnosed bladder cancer patients

Perspective on the use of optics in bladder cancer detection and diagnosis

Significance

Bladder cancer (BC) diagnosis, management, and outcomes depend on the accurate detection of tumors via optical technologies. Accordingly, understanding the benefits and limitations of these technologies permits improvements in patient care and identifies areas for future research.

Aim

We outline the current process of BC detection and diagnosis, explore the current role of optical technologies, and discuss the opportunities and challenges they present in this field.

Approach

The current diagnostic pathway of BC, the use of optical technologies, and their shortcomings in this process are reviewed. From there, opportunities and challenges of optics in BC detection and diagnosis are discussed.

Results

BC management is expensive due to the limitations of white light cystoscopy, the requirement for histopathological confirmation, and the need for long-term surveillance. Alternative non-optical methods lack accuracy, and available optical techniques focus only on cancer detection. Alternatives to histopathology need to provide accurate real-time results to be effective. Optical advancements offer potential benefits; however, challenges include cost-effectiveness, device complexity, required training, and tumor heterogeneity.

Conclusions

Optical techniques could accelerate BC diagnosis, reduce costs, and enable alternative treatments. However, overcoming technical and practical challenges is essential for their successful integration.

Exploring the influence of health and digital health literacy on quality of life and follow-up compliance in patients with primary non-muscle invasive bladder cancer: a prospective, single-center study

OBJECTIVE

Given the increasing significance of digital health literacy (DHL) and health literacy (HL) in promoting informed decision-making and healthy behaviors, this study aimed to assess the influence of self-reported HL and DHL on treatment adherence and quality of life among patients who underwent transurethral resection of bladder tumors (TUR-BT) for primary non-muscle invasive bladder cancer (NMIBC).

MATERIALS & METHODS

This single-center observational study involved patients who underwent TUR-BT for NIMBC at a tertiary hospital from May 2022 to February 2024. Before the procedure, the patients' DHL and HL were evaluated using the European Health Literacy Survey Questionnaire short version and the eHealth Literacy Scale. Six months after surgery, we surveyed patients' QoL using the EORTC QLQ-C30. In line with recommendations from the European Association of Urology guidelines, adherence to the treatment plan was assessed along with a follow-up cystoscopy examination for each patient.

RESULTS

Multivariate analysis revealed that poorer DHL and HL were significantly associated with older age (p < 0.001), lower educational attainment (p < 0.001), and lack of internet access (p < 0.001). Conversely, higher DHL and HL levels were positively correlated with increased treatment adherence, as measured by cystoscopy completion (p < 0.001). Additionally, logistic regression analysis demonstrated significant associations between improved DHL and HL scores and better global health status (DHL, p = 0.022; HL, p = 0.008), higher emotional status (p < 0.001 for both), and social functioning (p < 0.001 for both). Notably, there were no significant differences in the symptom scale scores between the DHL and HL groups.

CONCLUSION

To the best of our knowledge, this is the first study to explore the specific effect of HL/DHL on QoL and adherence in this patient population. Our research suggests that there may be a link between self-reported levels of DHL/HL and treatment adherence as well as QoL among patients with NIMBC.

[Bimodal and multimodal endoscopy of the urinary bladder in diagnosis and treatment]

White light cystoscopy is a precise instrument for the detection and treatment of papillary bladder tumors. Various additional macroscopic detection methods have been established. Some of them, especially PDD or NBI, have been shown to have an additional benefit on the recurrence rate of bladder tumors, so they should be used as part of the diagnosis and treatment when available. Other microscopic classification techniques or multimodality techniques are currently under development. Widespread use of these techniques is still pending. Newer modalities such as multi-parametric imaging or AI-assisted endoscopy promise a significant leap in innovation in the future and could ensure that real-time urological endoscopy is significantly advanced.

Trends in the use of immediate postoperative intravesical chemotherapy following transurethral resection of bladder tumors

PURPOSE

The use of immediate postoperative intravesical chemotherapy (IVC) following transurethral resection of bladder tumor (TURBT) has been shown to reduce the rate of recurrence of nonmuscle invasive bladder cancer. Historically, utilization of IVC following TURBT has been low. We sought to determine the rate of immediate postoperative IVC following TURBT, as well as assess factors that may influence its use.

METHODS

We utilized the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database to assess the rates of IVC between the years 2016 to 2021. All patients who underwent TURBT based on appropriate procedure codes were initially included. Patients with an additional procedure code for the administration of IVC were identified.

RESULTS

From 2016 to 2021, 50,295 patients underwent TURBT for bladder cancer. There were 21,544 (43%) small, 18,135 (36%) medium, and 10,616 (21%) large tumors treated. In total, 2,833 (5.6%) patients received IVC. Use of IVC was associated with surgery performed in an elective setting, those who did not receive preoperative blood transfusion, and shorter operative time. Receipt of chemotherapy was more common in the later years examined.

CONCLUSIONS

The rate of use of IVC remains very low. Ongoing study and improvement initiatives are in place, though these predominantly are assessing academic centers. Further study and quality improvement should be performed and include community practice settings.

Bladder cancer: non-coding RNAs and exosomal non-coding RNAs

Bladder cancer (BCa) is a highly prevalent type of cancer worldwide, and it is responsible for numerous deaths and cases of disease. Due to the diverse nature of this disease, it is necessary to conduct significant research that delves deeper into the molecular aspects, to potentially discover novel diagnostic and therapeutic approaches. Lately, there has been a significant increase in the focus on non-coding RNAs (ncRNAs), including microRNAs (miRNAs), long non-coding RNAs (lncRNAs), and circular RNAs (circRNAs), due to their growing recognition for their involvement in the progression and manifestation of BCa. The interest in exosomes has greatly grown due to their potential for transporting a diverse array of active substances, including proteins, nucleic acids, carbohydrates, and lipids. The combination of these components differs based on the specific cell and its condition. Research indicates that using exosomes could have considerable advantages in identifying and forecasting BCa, offering a less invasive alternative. The distinctive arrangement of the lipid bilayer membrane found in exosomes is what makes them particularly effective for administering treatments aimed at managing cancer. In this review, we have tried to summarize different ncRNAs that are involved in BCa pathogenesis. Moreover, we highlighted the role of exosomal ncRNAs in BCa.

Revolutionizing Treatment: Breakthrough Approaches for BCG-Unresponsive Non-Muscle-Invasive Bladder Cancer

Bladder cancer is the 10th most popular cancer in the world, and non-muscle-invasive bladder cancer (NMIBC) is diagnosed in ~80% of all cases. Treatments for NMIBC include transurethral resection of the bladder tumor (TURBT) and intravesical instillations of Bacillus Calmette-Guérin (BCG). Treatment of BCG-unresponsive tumors is scarce and usually leads to Radical Cystectomy. In this paper, we review recent advancements in conservative treatment of BCG-unresponsive tumors. The main focus of the paper is FDA-approved medications: Pembrolizumab and Nadofaragene Firadenovec (Adstiladrin). Other, less researched therapeutic possibilities are also included, namely: N-803 immunotherapy, TAR-200 and TAR-210 intravesical delivery systems and combined Cabazitaxel, Gemcitabine and Cisplatin chemotherapy. Conservative treatment and delaying radical cystectomy would greatly benefit patients' quality of life; it is undoubtedly the future of BCG-unresponsive NMIBC.