- Email: [email protected]
Management of High Grade Bladder Cancer: A Multidisciplinary Approach
Management of High Grade Bladder Cancer: A Multidisciplinary Approach
Fore w ord Management of High Grade Bladder Cancer: A M u l t i d i s c i p l i n a r y A p p ro a c h
Samir S. Taneja, MD
In the battlefield of Urologic Oncology, we face two distinct enemies. First, typically on the frontline, we are confronted with low-risk variants of urologic cancers that carry high prevalence and low risk of mortality. The management of lowgrade noninvasive bladder cancers, small incidental renal masses, and low-risk prostate cancers inundates our practice, but carries confusing, conflicted goals. In the case of lowrisk cancers, we wish to limit detection to those cancers that are truly harmful, reduce anxiety in our patients, limit treatment while minimizing the cost of surveillance, and avoid the morbidity of unnecessary treatment. We treat the low-risk cancer most often, but, in doing so, we rarely improve longevity. On the second line, often buried at a distant back end of the battlefield, we face our true nemesis, the lethal cancer. Most of us who do this for a living entered Urologic Oncology to save lives, but the lives that need saving are often beyond our grasp. In confronting lethal malignancies, we have learned that single-modality approaches generally fail. The use of multimodal therapy is pervasive in solid tumor oncology, but has been slow to infiltrate our own battle tactics in Urologic Oncology. Testis cancer may be the best example of success achieved through multimodal approach, and importantly, by introducing systemic therapy to
those with advanced disease, a role for surgery was carved out in the care of these patients. Now, reciprocally, systemic therapy is used efficaciously in men who would have previously been considered only for surgery. Such interactive, interdisciplinary approaches to disease serve only to elevate the game and provide better outcomes and more options for patients. High-risk and invasive bladder cancers, as a whole, are the most lethal cancers we face in Urologic Oncology. Even with aggressive, multimodal approaches, outcomes are not nearly as good as we would like them to be. Nonetheless, our management of these lethal cancers is distinct from lethal prostate or kidney malignancies in that we have developed multimodal approaches that clearly improve survival. Furthermore, those multimodal strategies have emerged as standard of care and have created new frontiers for exploration. In this issue of Urologic Clinics of North America, Drs Arjun Balar and Matthew Milowsky have put together a comprehensive series of articles outlining the multidisciplinary process that goes into optimizing care of the bladder cancer patient. The outstanding contributions of key opinion leaders in the field of bladder cancer not only illustrate the current state-of-the-art for caring for these patients but also create a strategic roadmap for where the field will go in years to come. This
Urol Clin N Am 42 (2015) xi–xii http://dx.doi.org/10.1016/j.ucl.2015.03.002 0094-0143/15/$ – see front matter Ó 2015 Published by Elsevier Inc.
urologic.theclinics.com
Consulting Editor
xii
Foreword issue of Urologic Clinics of North America should not only serve to educate the reader regarding the current optimal management of invasive bladder cancer but also fuel thought regarding strategies for the development of multimodal approaches in renal and prostate malignancies as well. I would like to personally thank Drs Balar and Milowsky, and each of the contributing authors, for this wonderful issue of Urologic Clinics of North America.
Samir S. Taneja, MD Division of Urologic Oncology Smilow Comprehensive Prostate Cancer Center Department of Urology NYU Langone Medical Center 150 East 32nd Street, Suite 200 New York, NY 10016, USA E-mail address: [email protected]
Fore w ord Management of High Grade Bladder Cancer: A M u l t i d i s c i p l i n a r y A p p ro a c h
Samir S. Taneja, MD
In the battlefield of Urologic Oncology, we face two distinct enemies. First, typically on the frontline, we are confronted with low-risk variants of urologic cancers that carry high prevalence and low risk of mortality. The management of lowgrade noninvasive bladder cancers, small incidental renal masses, and low-risk prostate cancers inundates our practice, but carries confusing, conflicted goals. In the case of lowrisk cancers, we wish to limit detection to those cancers that are truly harmful, reduce anxiety in our patients, limit treatment while minimizing the cost of surveillance, and avoid the morbidity of unnecessary treatment. We treat the low-risk cancer most often, but, in doing so, we rarely improve longevity. On the second line, often buried at a distant back end of the battlefield, we face our true nemesis, the lethal cancer. Most of us who do this for a living entered Urologic Oncology to save lives, but the lives that need saving are often beyond our grasp. In confronting lethal malignancies, we have learned that single-modality approaches generally fail. The use of multimodal therapy is pervasive in solid tumor oncology, but has been slow to infiltrate our own battle tactics in Urologic Oncology. Testis cancer may be the best example of success achieved through multimodal approach, and importantly, by introducing systemic therapy to
those with advanced disease, a role for surgery was carved out in the care of these patients. Now, reciprocally, systemic therapy is used efficaciously in men who would have previously been considered only for surgery. Such interactive, interdisciplinary approaches to disease serve only to elevate the game and provide better outcomes and more options for patients. High-risk and invasive bladder cancers, as a whole, are the most lethal cancers we face in Urologic Oncology. Even with aggressive, multimodal approaches, outcomes are not nearly as good as we would like them to be. Nonetheless, our management of these lethal cancers is distinct from lethal prostate or kidney malignancies in that we have developed multimodal approaches that clearly improve survival. Furthermore, those multimodal strategies have emerged as standard of care and have created new frontiers for exploration. In this issue of Urologic Clinics of North America, Drs Arjun Balar and Matthew Milowsky have put together a comprehensive series of articles outlining the multidisciplinary process that goes into optimizing care of the bladder cancer patient. The outstanding contributions of key opinion leaders in the field of bladder cancer not only illustrate the current state-of-the-art for caring for these patients but also create a strategic roadmap for where the field will go in years to come. This
Urol Clin N Am 42 (2015) xi–xii http://dx.doi.org/10.1016/j.ucl.2015.03.002 0094-0143/15/$ – see front matter Ó 2015 Published by Elsevier Inc.
urologic.theclinics.com
Consulting Editor
xii
Foreword issue of Urologic Clinics of North America should not only serve to educate the reader regarding the current optimal management of invasive bladder cancer but also fuel thought regarding strategies for the development of multimodal approaches in renal and prostate malignancies as well. I would like to personally thank Drs Balar and Milowsky, and each of the contributing authors, for this wonderful issue of Urologic Clinics of North America.
Samir S. Taneja, MD Division of Urologic Oncology Smilow Comprehensive Prostate Cancer Center Department of Urology NYU Langone Medical Center 150 East 32nd Street, Suite 200 New York, NY 10016, USA E-mail address: [email protected]