Advertisement

World Journal of Urology

, Volume 37, Issue 1, pp 51–60 | Cite as

ICUD-SIU International Consultation on Bladder Cancer 2017: management of non-muscle invasive bladder cancer

  • Leonardo L. Monteiro
  • J. Alfred Witjes
  • Piyush K. Agarwal
  • Christopher B. Anderson
  • Trinity J. Bivalacqua
  • Bernard H. Bochner
  • Joost L. Boormans
  • Sam S. Chang
  • Jose L. Domínguez-Escrig
  • James M. McKiernan
  • Colin Dinney
  • Guilherme Godoy
  • Girish S. Kulkarni
  • Paramananthan Mariappan
  • Michael A. O’Donnell
  • Cyrill A. Rentsch
  • Jay B. Shah
  • Eduardo Solsona
  • Robert S. Svatek
  • Antoine G. van der Heijden
  • F. Johannes P. van Valenberg
  • Wassim KassoufEmail author
Invited Review

Abstract

Purpose

To provide a summary of the Third International Consultation on Bladder Cancer recommendations for the management of non-muscle invasive bladder cancer (NMIBC).

Methods

A detailed review of the literature was performed focusing on original articles for the management of NMIBC. An international committee assessed and graded the articles based on the Oxford Centre for Evidence-based Medicine system. The entire spectrum of NMIBC was covered such as prognostic factors of recurrence and progression, risk stratification, staging, management of positive urine cytology with negative white light cystoscopy, indications of bladder and prostatic urethral biopsies, management of Ta low grade (LG) and high risk tumors (Ta high grade [HG], T1, carcinoma in situ [CIS]), impact of BCG strain and host on outcomes, management of complications of intravesical therapy, role of alternative therapies, indications for early cystectomy, surveillance strategies, and new treatments. The working group provides several recommendations on the management of NMIBC.

Results

Recommendations were summarized with regard to staging; management of primary and recurrent LG Ta and high risk disease, positive urine cytology with negative white light cystoscopy and prostatic urethral involvement; indications for timely cystectomy; and surveillance strategies.

Conclusion

NMIBC remains a common and challenging malignancy to manage. Accurate staging, grading, and risk stratification are critical determinants of the management and outcomes of these patients. Current tools for risk stratification are limited but informative, and should be used in clinical practice when determining diagnosis, surveillance, and treatment of NMIBC.

Keywords

Bladder cancer Non-muscle invasive bladder cancer Transurethral resection of bladder tumor Staging Diagnosis Treatment Surveillance Bacillus Calmette–Guerin Guidelines ICUD 

Notes

Author contributions

LLM: manuscript writing/editing, project development. JAW: manuscript writing/editing. PKA: manuscript writing. CBA: manuscript writing. TJB: manuscript writing. BHB: manuscript writing. JLB: manuscript writing. SSC: manuscript writing. JLD: manuscript writing. JMM: manuscript writing. CD: manuscript writing. GG: manuscript writing. GSK: manuscript writing. PM: manuscript writing. MAO: manuscript writing. CAR: manuscript writing. JBS: manuscript writing. ES: manuscript writing. RSS: manuscript writing. AGH: manuscript writing. FJPV: manuscript writing. WK: manuscript writing/editing, project development

Compliance with ethical standards

Conflict of interest

Author JA Witjes has relationship with Sanofi Pasteur, MEL Amsterdam (Synergo), Cepheid, Nucleix, BMS, Taris, BioCancel and Spectrum. Author SS Chang has relationship with Mdx Health, BioCancel, Bristol Myers Squibb, and Altor. Author GS Kulkarni has received research funds from Biosyent Canada. Author MA O’Donnell has relationship with Abbot Molecular, Roche, Photocure, Urogen, Medical Enterprises, Viventia, Spectrum, Fidia Pharmaceuticals, Vaxiion Pharmaceuticals, and Therlasae. The other authors declare that they have no conflict of interest.

Research involving human participants and/or animals

For this type of study formal consent is not required. This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this type of study formal consent is not required.

References

  1. 1.
    Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F (2015) Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 136(5):E359–E386.  https://doi.org/10.1002/ijc.29210 Google Scholar
  2. 2.
    Ploeg M, Aben KK, Kiemeney LA (2009) The present and future burden of urinary bladder cancer in the world. World J Urol 27(3):289–293.  https://doi.org/10.1007/s00345-009-0383-3 Google Scholar
  3. 3.
    Antoni S, Ferlay J, Soerjomataram I, Znaor A, Jemal A, Bray F (2017) Bladder cancer incidence and mortality: a global overview and recent trends. Eur Urol 71(1):96–108.  https://doi.org/10.1016/j.eururo.2016.06.010 Google Scholar
  4. 4.
    Burger M, Catto JW, Dalbagni G, Grossman HB, Herr H, Karakiewicz P, Kassouf W, Kiemeney LA, La Vecchia C, Shariat S, Lotan Y (2013) Epidemiology and risk factors of urothelial bladder cancer. Eur Urol 63(2):234–241.  https://doi.org/10.1016/j.eururo.2012.07.033 Google Scholar
  5. 5.
    Philips B, Ball C, Sackett D, et al (2009) Oxford Centre for Evidence-based medicine—levels of evidence (March 2009). http://www.cebm.net/oxford-centre-evidence-based-medicine-levels-evidence-march-2009/. Accessed 15 June, 2017
  6. 6.
    Sobin LH, Gospodarowicz MK, Wittekind C (2010) TNM classification of malignant tumours, 7th edn. Wiley-Blackwell, ChichesterGoogle Scholar
  7. 7.
    Brierley JD, Gospodarowicz MK, Wittekind C (2017) TNM classification of malignant tumours, 8th edn. Wiley-Blackwell, ChichesterGoogle Scholar
  8. 8.
    Sylvester RJ, van der Meijden AP, Oosterlinck W, Witjes JA, Bouffioux C, Denis L, Newling DW, Kurth K (2006) Predicting recurrence and progression in individual patients with stage Ta T1 bladder cancer using EORTC risk tables: a combined analysis of 2596 patients from seven EORTC trials. Eur Urol 49(3):466–477.  https://doi.org/10.1016/j.eururo.2005.12.031 Google Scholar
  9. 9.
    Fernandez-Gomez J, Madero R, Solsona E, Unda M, Martinez-Pineiro L et al (2009) Predicting nonmuscle invasive bladder cancer recurrence and progression in patients treated with bacillus Calmette-Guerin: the CUETO scoring model. J Urol 182(5):2195–2203.  https://doi.org/10.1016/j.juro.2009.07.016 Google Scholar
  10. 10.
    Soloway MS, Patel J (1992) Surgical techniques for endoscopic resection of bladder cancer. Urol Clin North Am 19(3):467–471Google Scholar
  11. 11.
    Ukai R, Kawashita E, Ikeda H (2000) A new technique for transurethral resection of superficial bladder tumor in 1 piece. J Urol 163(3):878–879.  https://doi.org/10.1016/S0022-5347(05)67824-X Google Scholar
  12. 12.
    Bladder cancer. A Joint SIU-ICUD International Consultation. Lisbon, Portugal. Available at: http://www.siu-urology.org/society/siu-icud. Accessed 19 Oct, 2017 In press
  13. 13.
    Koplay M, Kantarci M, Guven F, Aksoy Y, Taser F, Ziypak T, Eren S, Levent A, Atamanalp SS (2010) Diagnostic efficiency of multidetector computed tomography with multiplanar reformatted imaging and virtual cystoscopy in the assessment of bladder tumors after transurethral resection. J Comput Assist Tomogr 34(1):121–126.  https://doi.org/10.1097/RCT.0b013e3181b728ae Google Scholar
  14. 14.
    El-Assmy A, Abou-El-Ghar ME, Mosbah A, El-Nahas AR, Refaie HF, Hekal IA, El-Diasty T, el Ibrahiem H (2009) Bladder tumour staging: comparison of diffusion- and T2-weighted MR imaging. Eur Radiol 19(7):1575–1581.  https://doi.org/10.1007/s00330-009-1340-7 Google Scholar
  15. 15.
    Watanabe H, Kanematsu M, Kondo H, Goshima S, Tsuge Y, Onozuka M, Moriyama N (2009) Preoperative T staging of urinary bladder cancer: does diffusion-weighted MRI have supplementary value? AJR Am J Roentgenol 192(5):1361–1366.  https://doi.org/10.2214/AJR.08.1430 Google Scholar
  16. 16.
    Lodde M, Lacombe L, Friede J, Morin F, Saourine A, Fradet Y (2010) Evaluation of fluorodeoxyglucose positron-emission tomography with computed tomography for staging of urothelial carcinoma. BJU Int 106(5):658–663.  https://doi.org/10.1111/j.1464-410X.2010.09212.x Google Scholar
  17. 17.
    Saokar A, Islam T, Jantsch M, Saksena MA, Hahn PF, Harisinghani MG (2010) Detection of lymph nodes in pelvic malignancies with computed tomography and magnetic resonance imaging. Clin Imaging 34(5):361–366.  https://doi.org/10.1016/j.clinimag.2009.07.004 Google Scholar
  18. 18.
    Babjuk M, Bohle A, Burger M, Capoun O, Cohen D, Comperat EM, Hernandez V, Kaasinen E, Palou J, Roupret M, van Rhijn BW, Shariat SF, Soukup V, Sylvester RJ, Zigeuner R (2017) EAU guidelines on non-muscle invasive bladder cancer: update 2016. Eur Urol 71(3):447–461.  https://doi.org/10.1016/j.eururo.2016.05.041 Google Scholar
  19. 19.
    Chang S, Boorjian S, Chou R, Clark PE, Daneshmand S, Konety BR, Pruthi R, Quale DZ, Ritch CR, Seigne JD, Skinner EC, Smith ND, McKiernan JM (2016) Diagnosis and treatment of non-muscle invasive bladder cancer: AUA/SOU guidelines. J Urol 196(4):1021–1029.  https://doi.org/10.1016/j.juro.2016.06.049 Google Scholar
  20. 20.
    Goessl C, Knispel HH, Miller K, Klan R (1997) Is routine excretory urography necessary at first diagnosis of bladder cancer? J Urol 157(2):480–481.  https://doi.org/10.1016/S0022-5347(01)65180-2 Google Scholar
  21. 21.
    Palou J, Rodriguez-Rubio F, Huguet J, Segarra J, Ribal MJ, Alcaraz A, Villavicencio H (2005) Multivariate analysis of clinical parameters of synchronous primary superficial bladder cancer and upper urinary tract tumor. J Urol 174(3):859–861.  https://doi.org/10.1097/01.ju.0000169424.79702.6d Google Scholar
  22. 22.
    Millian-Rodriguez F, CheChile-Toniolo G, Salvador-Bayarri J, Huguet-Perez J, Vicente-Rodriguez J (2000) Upper urinary tract tumors after primary superficial bladder tumors: prognostic factors and risk groups. J Urol 164(4):1183–1187.  https://doi.org/10.1016/S0022-5347(05)67137-6 Google Scholar
  23. 23.
    Millan-Rodriguez F, Chechile-Toniolo G, Salvador-Bayarri J, Palou J, Algaba F, Vicente-Rodriguez J (2000) Primary superficial bladder cancer risk groups according to progression, mortality and recurrence. J Urol 164(3 Pt 1):680–684.  https://doi.org/10.1016/S0022-5347(05)67280-1 Google Scholar
  24. 24.
    Sylvester RJ, Oosterlinck W, Witjes JA (2008) The schedule and duration of intravesical chemotherapy in patients with non-muscle-invasive bladder cancer: a systematic review of the published results of randomized clinical trials. Eur Urol 53(4):709–719.  https://doi.org/10.1016/j.eururo.2008.01.015 Google Scholar
  25. 25.
    Kamat AM, Witjes JA, Brausi M, Soloway M, Lamm D, Persad R, Buckley R, Böhle A, Colombel M, Palou J (2014) Defining and treating the spectrum of intermediate risk nonmuscle invasive bladder cancer. J Urol 192(2):305–315.  https://doi.org/10.1016/j.uro.2014.02.2573 Google Scholar
  26. 26.
    Adiyat KT, Katkoori D, Soloway CT, De los Santos R, Manoharan M, Soloway MS (2010) “Complete transurethral resection of bladder tumor”: are the guidelines being followed? Urology 75(2):365–367.  https://doi.org/10.1016/j.urology.2009.08.082 Google Scholar
  27. 27.
    Chamie K, Ballon-Landa E, Bassett JC, Daskivich TJ, Leventhal M, Deapen D, Litwin MS (2015) Quality of diagnostic staging in patients with bladder cancer: a process-outcomes link. Cancer 121(3):379–385.  https://doi.org/10.1002/cncr.29071 Google Scholar
  28. 28.
    Herr HW (2015) Role of repeat resection in non-muscle-invasive bladder cancer. J Natl Compr Canc Netw 13(8):1041–1046.  https://doi.org/10.6004/jnccn.2015.0123 Google Scholar
  29. 29.
    Cai T, Nesi G, Tinacci G, Zini E, Mondaini N, Boddi V, Mazzoli S, Bartoletti R (2008) Can early single dose instillation of epirubicin improve bacillus Calmette-Guerin efficacy in patients with nonmuscle invasive high risk bladder cancer? Results from a prospective, randomized, double-blind controlled study. J Urol 180(1):110–115.  https://doi.org/10.1016/j.juro.2008.03.038 Google Scholar
  30. 30.
    Chou R, Selph S, Buckley DI, Fu R, Griffin JC, Grusing S, Gore JL (2017) Intravesical therapy for the treatment of nonmuscle invasive bladder cancer: a systematic review and meta-analysis. J Urol 197(5):1189–1199.  https://doi.org/10.1016/j.juro.2016.12.090 Google Scholar
  31. 31.
    Lamm DL, Blumenstein BA, Crissman JD, Montie JE, Gottesman JE, Lowe BA, Sarosdy MF, Bohl RD, Grossman HB, Beck TM, Leimert JT, Crawford ED (2000) Maintenance bacillus Calmette-Guerin immunotherapy for recurrent TA, T1 and carcinoma in situ transitional cell carcinoma of the bladder: a randomized Southwest oncology group study. J Urol 163(4):1124–1129.  https://doi.org/10.1016/S0022-5347(05)67707-5 Google Scholar
  32. 32.
    Martinez-Pineiro JA, Flores N, Isorna S, Solsona E, Sebastian JL, Pertusa C, Rioja LA, Martinez-Pineiro L, Vela R, Camacho JE, Nogueira JL, Pereira I, Resel L, Muntanola P, Galvis F, Chesa N, De Torres JA, Carballido J, Bernuy C, Arribas S, Madero R, For CUETO (Club Urologico Espanol de Tratamiento Oncologico) (2002) Long-term follow-up of a randomized prospective trial comparing a standard 81 mg dose of intravesical bacille Calmette-Guerin with a reduced dose of 27 mg in superficial bladder cancer. BJU int 89(7):671–680.  https://doi.org/10.1046/j.1464-410X.2002.02722.x Google Scholar
  33. 33.
    Lammers RJ, Witjes WP, Hendricksen K, Caris CT, Janzing-Pastors MH, Witjes JA (2011) Smoking status is a risk factor for recurrence after transurethral resection of non-muscle-invasive bladder cancer. Eur Urol 60(4):713–720.  https://doi.org/10.1016/j.eururo.2011.07.010 Google Scholar
  34. 34.
    Rink M, Furberg H, Zabor EC, Xylinas E, Babjuk M, Pycha A, Lotan Y, Karakiewicz PI, Novara G, Robinson BD, Montorsi F, Chun FK, Scherr DS, Shariat SF (2013) Impact of smoking and smoking cessation on oncologic outcomes in primary non-muscle-invasive bladder cancer. Eur Urol 63(4):724–732.  https://doi.org/10.1016/j.eururo.2012.08.025 Google Scholar
  35. 35.
    Herr HW, Dalbagni G (2003) Defining bacillus Calmette-Guerin refractory superficial bladder tumors. J Urol 169(5):1706–1708.  https://doi.org/10.1097/01.ju.0000062605.92268.c6 Google Scholar
  36. 36.
    Haas CR, Barlow LJ, Badalato GM, DeCastro GJ, Benson MC, McKiernan JM (2016) The timing of radical cystectomy for bacillus Calmette-Guerin failure: comparison of outcomes and risk factors for prognosis. J Urol 195(6):1704–1709.  https://doi.org/10.1016/j.juro.2016.01.087 Google Scholar
  37. 37.
    Gupta S, Gill D, Poole A, Agarwal N (2017) Systemic immunotherapy for urothelial cancer: current trends and future directions. Cancers 9(2):E15.  https://doi.org/10.3390/cancers9020015 Google Scholar
  38. 38.
    Steinberg G, Bahnson R, Brosman S, Middleton R, Wajsman Z, Wehle M (2000) Efficacy and safety of valrubicin for the treatment of Bacillus Calmette-Guerin refractory carcinoma in situ of the bladder. The Valrubicin Study Group. J Urol 163(3):761–767.  https://doi.org/10.1016/S0022-5347(05)67799-3 Google Scholar
  39. 39.
    Barlow LJ, McKiernan JM, Benson MC (2013) Long-term survival outcomes with intravesical docetaxel for recurrent nonmuscle invasive bladder cancer after previous bacillus Calmette-Guerin therapy. J Urol 189(3):834–839.  https://doi.org/10.1016/j.juro.2012.10.068 Google Scholar
  40. 40.
    Gallagher BL, Joudi FN, Maymi JL, O’Donnell MA (2008) Impact of previous bacille Calmette-Guerin failure pattern on subsequent response to bacille Calmette-Guerin plus interferon intravesical therapy. Urology 71(2):297–301.  https://doi.org/10.1016/j.urology.2007.09.050 Google Scholar
  41. 41.
    Kamat AM, Colombel M, Sundi D, Lamm D, Boehle A, Brausi M, Buckley R, Persad R, Palou J, Soloway M, Witjes JA (2017) BCG-unresponsive non-muscle-invasive bladder cancer: recommendations from the IBCG. Nat Rev Urol 14(4):244–255.  https://doi.org/10.1038/nrurol.2017.16 Google Scholar
  42. 42.
    Lammers RJ, Witjes JA, Inman BA, Leibovitch I, Laufer M, Nativ O, Colombo R (2011) The role of a combined regimen with intravesical chemotherapy and hyperthermia in the management of non-muscle-invasive bladder cancer: a systematic review. Eur Urol 60(1):81–93.  https://doi.org/10.1016/j.eururo.2011.04.023 Google Scholar
  43. 43.
    Di Stasi SM, Giannantoni A, Stephen RL, Capelli G, Navarra P, Massoud R, Vespasiani G (2003) Intravesical electromotive mitomycin C versus passive transport mitomycin C for high risk superficial bladder cancer: a prospective randomized study. J Urol 170(3):777–782.  https://doi.org/10.1097/01.ju.0000080568.91703.18 Google Scholar
  44. 44.
    Weiss C, Wolze C, Engehausen DG, Ott OJ, Krause FS, Schrott KM, Dunst J, Sauer R, Rodel C (2006) Radiochemotherapy after transurethral resection for high-risk T1 bladder cancer: an alternative to intravesical therapy or early cystectomy? J Clin Oncol 24(15):2318–2324.  https://doi.org/10.1200/JCO.2006.05.8149 Google Scholar
  45. 45.
    Karl A, Tritschler S, Stanislaus P, Gratzke C, Tilki D, Strittmatter F, Knuchel R, Stief CG, Zaak D (2009) Positive urine cytology but negative white-light cystoscopy: an indication for fluorescence cystoscopy? BJU Int 103(4):484–487.  https://doi.org/10.1111/j.1464-410X.2008.08032.x Google Scholar
  46. 46.
    Gopalakrishna A, Fantony JJ, Longo TA, Owusu R, Foo WC, Dash R, Denton BT, Inman BA (2017) Anticipatory positive urine tests for bladder cancer. Ann Surg Oncol 24(6):1747–1753.  https://doi.org/10.1245/s10434-016-5763-5 Google Scholar
  47. 47.
    Ray ER, Chatterton K, Khan MS, Thomas K, Chandra A, O’Brien TS (2009) Hexylaminolaevulinate ‘blue light’ fluorescence cystoscopy in the investigation of clinically unconfirmed positive urine cytology. BJU Int 103(10):1363–1367.  https://doi.org/10.1111/j.1464-410X.2008.08238.x Google Scholar
  48. 48.
    Redorta JP, Schatteman P, Perez JH, Tomas JS, Bordes AR, Algaba F, Mavrich HV (2006) Intravesical instillations with bacillus Calmette-Guerin for the treatment of carcinoma in situ involving prostatic ducts. Eur Urol 49(5):834–838.  https://doi.org/10.1016/j.eururo.2005.12.019 Google Scholar
  49. 49.
    Taylor JH, Davis J, Schellhammer P (2007) Long-term follow-up of intravesical bacillus Calmette-Guerin treatment for superficial transitional-cell carcinoma of the bladder involving the prostatic urethra. Clin Genitourin Cancer 5(6):386–389.  https://doi.org/10.3816/CGC.2007.n.021 Google Scholar
  50. 50.
    Knoedler JJ, Boorjian SA, Tollefson MK, Cheville JC, Thapa P, Tarrell RF, Frank I (2014) Urothelial carcinoma involving the prostate: the association of revised tumour stage and coexistent bladder cancer with survival after radical cystectomy. BJU int 114(6):832–836.  https://doi.org/10.1111/bju.12486 Google Scholar
  51. 51.
    Martin-Doyle W, Leow JJ, Orsola A, Chang SL, Bellmunt J (2015) Improving selection criteria for early cystectomy in high-grade t1 bladder cancer: a meta-analysis of 15,215 patients. J Clin Oncol 33(6):643–650.  https://doi.org/10.1200/JCO.2014.57.6967 Google Scholar
  52. 52.
    Herr HW, Sogani PC (2001) Does early cystectomy improve the survival of patients with high risk superficial bladder tumors? J Urol 166(4):1296–1299.  https://doi.org/10.1016/S0022-5347(05)65756-4 Google Scholar
  53. 53.
    Yafi FA, Brimo F, Steinberg J, Aprikian AG, Tanguay S, Kassouf W (2015) Prospective analysis of sensitivity and specificity of urinary cytology and other urinary biomarkers for bladder cancer. Urol Oncol 33(2):66.e25–66.e31.  https://doi.org/10.1016/j.urolonc.2014.06.008 Google Scholar
  54. 54.
    Lokeshwar VB, Habuchi T, Grossman HB, Murphy WM, Hautmann SH, Hemstreet GP 3rd, Bono AV, Getzenberg RH, Goebell P, Schmitz-Drager BJ, Schalken JA, Frade Y, Marberger M, Messing E, Droller MJ (2005) Bladder tumor markers beyond cytology: International Consensus Panel on bladder tumor markers. Urology 66(6 Suppl 1):35–63.  https://doi.org/10.1016/j.urology.2005.08.064 Google Scholar
  55. 55.
    Kassouf W, Witjes JA et al. (2018) ICUD-SIU International Consultation on Bladder Cancer 2017: management of non-muscle invasive bladder cancer. ICUD-SIU bladder guideline book (NMIBC section). In: Black, P and Gontero, P (eds). https://www.siu-urology.org/society/siu-icud. Accessed 10 May 2018

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Leonardo L. Monteiro
    • 1
  • J. Alfred Witjes
    • 2
  • Piyush K. Agarwal
    • 3
  • Christopher B. Anderson
    • 4
  • Trinity J. Bivalacqua
    • 5
  • Bernard H. Bochner
    • 6
  • Joost L. Boormans
    • 7
  • Sam S. Chang
    • 8
  • Jose L. Domínguez-Escrig
    • 9
  • James M. McKiernan
    • 4
  • Colin Dinney
    • 10
  • Guilherme Godoy
    • 11
  • Girish S. Kulkarni
    • 12
  • Paramananthan Mariappan
    • 13
  • Michael A. O’Donnell
    • 14
  • Cyrill A. Rentsch
    • 15
  • Jay B. Shah
    • 16
  • Eduardo Solsona
    • 9
  • Robert S. Svatek
    • 17
  • Antoine G. van der Heijden
    • 2
  • F. Johannes P. van Valenberg
    • 2
  • Wassim Kassouf
    • 1
    Email author
  1. 1.Division of UrologyMcGill University Health Center—Glen SiteMontrealCanada
  2. 2.Department of UrologyRadboud University Medical CentreNijmegenThe Netherlands
  3. 3.Urologic Oncology BranchNational Cancer InstituteBethesdaUSA
  4. 4.Department of UrologyColumbia UniversityNew YorkUSA
  5. 5.The James Buchanan Brady Urological InstituteThe Johns Hopkins University School of MedicineBaltimoreUSA
  6. 6.Urology Service, Department of SurgeryKimmel Center for Prostate and Urologic Cancers, Memorial Sloan Kettering Cancer CenterNew YorkUSA
  7. 7.Department of UrologyErasmus MC Cancer InstituteRotterdamThe Netherlands
  8. 8.Ingram Cancer CenterVanderbilt UniversityTennesseeUSA
  9. 9.Department of UrologyInstituto Valenciano de OncologíaValenciaSpain
  10. 10.Department of UrologyMD Anderson Cancer CenterHoustonUSA
  11. 11.Scott Department of UrologyBaylor College of MedicineHoustonUSA
  12. 12.Division of Urology, Department of Surgery and Surgical Oncology, Princess Margaret Cancer CentreUniversity of TorontoTorontoCanada
  13. 13.Department of Urology, Western General HospitalUniversity of EdinburghEdinburghUK
  14. 14.University of IowaIowa CityUSA
  15. 15.Department of UrologyUniversity of BaselBaselSwitzerland
  16. 16.Department of UrologyStanford University School of MedicineStanfordUSA
  17. 17.Department of Urology, Division of Urologic OncologyThe University of Texas Health San AntonioSan AntonioUSA

Personalised recommendations