BACKGROUND: Although guidelines exist for advanced and variant bladder cancer management, evidence is limited/conflicting in some areas and the optimal approach remains controversial. OBJECTIVE: To bring together a large multidisciplinary group of experts to develop consensus statements on controversial topics in bladder cancer management. DESIGN: A steering committee compiled proposed statements regarding advanced and variant bladder cancer management which were assessed by 113 experts in a Delphi survey. Statements not reaching consensus were reviewed; those prioritised were revised by a panel of 45 experts before voting during a consensus conference. SETTING: Online Delphi survey and consensus conference. PARTICIPANTS: The European Association of Urology (EAU), the European Society for Medical Oncology (ESMO), experts in bladder cancer management. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Statements were ranked by experts according to their level of agreement: 1-3 (disagree), 4-6 (equivocal), 7-9 (agree). A priori (level 1) consensus was defined as ≥70% agreement and ≤15% disagreement, or vice versa. In the Delphi survey, a second analysis was restricted to stakeholder group(s) considered to have adequate expertise relating to each statement (to achieve level 2 consensus). RESULTS AND LIMITATIONS: Overall, 116 statements were included in the Delphi survey. Of these, 33 (28%) statements achieved level 1 consensus and 49 (42%) statements achieved level 1 or 2 consensus. At the consensus conference, 22 of 27 (81%) statements achieved consensus. These consensus statements provide further guidance across a broad range of topics, including the management of variant histologies, the role/limitations of prognostic biomarkers in clinical decision making, bladder preservation strategies, modern radiotherapy techniques, the management of oligometastatic disease and the evolving role of checkpoint inhibitor therapy in metastatic disease. CONCLUSIONS: These consensus statements provide further guidance on controversial topics in advanced and variant bladder cancer management until a time where further evidence is available to guide our approach.

• MeSH
• Delphi Technique MeSH
• Consensus * MeSH
• Medical Oncology methods   standards   MeSH
• Humans MeSH
• International Cooperation MeSH
• Urinary Bladder pathology   MeSH
• Urinary Bladder Neoplasms pathology   therapy   MeSH
• Surveys and Questionnaires MeSH
• Practice Guidelines as Topic * MeSH
• Societies, Medical standards   MeSH
• Neoplasm Staging MeSH
• Stakeholder Participation MeSH
• Urology methods   standards   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Geographicals
• Europe MeSH

Peroperační léčba karcinomu močového měchýře invadujícího svalovinu se v posledních letech stala standardem. Nové látky jako inhibitory PD1/PD-L1 otevřely u metastazujícího karcinomu močového měchýře dveře pro imunomodulační léčbu. Článek se zaměřuje na data, která již změnila nebo mají potenciál změnit medikamentozní léčbu pokročilého karcinomu močového měchýře, doprovázená přehledem literatury a relevantních informací z hlavních odborných setkání (EAU, ASCO, GU-ASCO, AUA).

Perioperative treatment of muscle invasive bladder cancer has become standard in the last years. New agents like PD1/PD-L1 inhibitors have opened the door for immunomodulating therapy in metastasized bladder cancer. This article focuses on data which has changed or has the potential to change the medical treatment of advanced bladder cancer with a review of literature and proceedings of major meetings (EAU, ASCO, GU-ASCO, AUA).

• MeSH
• Chemotherapy, Adjuvant classification   MeSH
• Survival Analysis MeSH
• B7-H1 Antigen MeSH
• Molecular Targeted Therapy MeSH
• Cisplatin therapeutic use   MeSH
• Double-Blind Method MeSH
• Immunomodulation MeSH
• Clinical Trials, Phase II as Topic MeSH
• Clinical Trials, Phase III as Topic MeSH
• Drug Therapy, Combination MeSH
• Humans MeSH
• Meta-Analysis as Topic MeSH
• Neoplasm Metastasis drug therapy   MeSH
• Antibodies, Monoclonal adverse effects   therapeutic use   MeSH
• Urinary Bladder Neoplasms * drug therapy   MeSH
• Randomized Controlled Trials as Topic MeSH
• Treatment Outcome MeSH
• Check Tag
• Humans MeSH

U pacientů s metastazujícím karcinomem prostaty v pokročilém stadiu je indikována systémová terapie. Po diagnostikování onemocnění je zahájena androgenní deprivační léčba s cílem snížit hodnotu androgenů na kastrační hladinu. Tuto léčbu lze kombinovat s chemoterapií na bázi docetaxelu, zejména u pacientů s tumory o větším objemu. Pokud dojde k progresi karcinomu i navzdory dostatečné kastrační hladině androgenů, hovoříme o karcinomu prostaty rezistentním na kastrační léčbu. V současné době, kdy se objevují stále nové přípravky pro léčbu karcinomu prostaty rezistentního na kastraci (abirateron, enzalutamid, kabazitaxel, chlorid radnatý 223), je nezbytné zohlednit registrační kritéria a profil nežádoucích účinků. Tento článek poskytuje přehled současných možností pro systémovou ­léčbu metastazujícího karcinomu prostaty, který dosud nebyl léčen hormonálně, a karcinomu prostaty rezistentního na kastraci.

In patients with advanced, metastastic prostate cancer systemic therapy is indicated. At initial diagnosis, these patients are treated with androgen-deprivation therapy in order to lower androgen-levels at castration-level. This treatment initially can be combined with docetaxel chemotherapy, especially in patients with higher tumor burden. If prostate cancer progresses despite adequate castration level of androgens, we speak of castration-resistant prostate cancer. In the background of rapidly evolving new treatment options for castration-resistant prostate cancer - namely abiraterone, enzalutamide, cabazitaxel, radium-223-dichloride - the approval criteria and side-effect profile have to be taken into account. The following article summarizes curent systemic treatment options for metastatic hormone-na?ve and castration-resistant prostate cancer.

• Keywords
• metastazující karcinom prostaty rezistentní na kastrační léčbu, kombinace chemoterapie a hormonální léčby, chlorid radnatý-223, kabazitaxel, enzalutamid, Alpharadin,
• MeSH
• Abiraterone Acetate MeSH
• Androstenes adverse effects   therapeutic use   MeSH
• Antineoplastic Agents, Hormonal adverse effects   therapeutic use   MeSH
• Antineoplastic Agents adverse effects   therapeutic use   MeSH
• Docetaxel MeSH
• Phenylthiohydantoin analogs & derivatives   adverse effects   therapeutic use   MeSH
• Clinical Trials, Phase II as Topic MeSH
• Clinical Trials, Phase III as Topic MeSH
• Drug Therapy, Combination * methods   MeSH
• Humans MeSH
• Neoplasm Metastasis drug therapy   MeSH
• Tubulin Modulators adverse effects   therapeutic use   MeSH
• Prostatic Neoplasms * drug therapy   MeSH
• Antineoplastic Combined Chemotherapy Protocols adverse effects   therapeutic use   MeSH
• Radioisotopes adverse effects   therapeutic use   MeSH
• Radium adverse effects   therapeutic use   MeSH
• Randomized Controlled Trials as Topic MeSH
• Taxoids adverse effects   therapeutic use   MeSH
• Check Tag
• Humans MeSH