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High-grade T1 Urothelial Carcinoma: Where Do We Stand?

  • Urothelial Cancer (S Daneshmand, Section Editor)
  • Published:
Current Urology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Bladder cancer is a deadly and common malignancy, with 24% of new cases presenting as T1 disease. High-grade T1 in particular represents a difficult entity to treat due to its clinical variability and known risks of recurrence, progression, and cancer-specific mortality. The differences in guidelines from major urologic organizations underscore this variability, and the past year has seen another BCG shortage, further complicating management. Advances have been made in the molecular and genomic characterization of high-grade T1, and new clinical trials are available to investigate alternative therapies. In this review, we summarize the variations in guidelines, alternatives to BCG, emerging molecular and genomic discoveries, and recent clinical trials.

Recent Findings

Adherence to guidelines for non-muscle-invasive bladder cancer in the community among practicing urologists remains low, in part due to the variations in available guidelines. In the era of a BCG shortage, decreased dosing schedules and alternative intravesical options are increasingly being used. New biomarkers are being discovered to better risk-stratify patients, with future therapies aimed at targeting aggressive disease.

Summary

HGT1 urothelial carcinoma remains a highly variable and aggressive disease, but we are making significant progress in better characterizing the clinical and molecular factors that influence recurrence and progression, to better guide management.

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  1. USC Institute of Urology/Norris Comprehensive Cancer Center, 1441 Eastlake Ave, Los Angeles, CA, 90033, USA

    Wesley Yip, Akbar Ashrafi & Siamak Daneshmand

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  1. Wesley Yip
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Correspondence to Siamak Daneshmand.

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Wesley Yip and Akbar Ashrafi each declare no potential conflicts of interest. Siamak Daneshmand is a section editor for Current Urology Reports.

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This article is part of the Topical Collection on Urothelial Cancer

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Yip, W., Ashrafi, A. & Daneshmand, S. High-grade T1 Urothelial Carcinoma: Where Do We Stand?. Curr Urol Rep 20, 79 (2019). https://doi.org/10.1007/s11934-019-0945-x

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