Posttreatment cTa, cT1, Tis recurrent or persistent cancer

Question 1

What are the three profiles of patients with suspected recurrent and persistent cancer?

Answer 1

1. CYSTOSCOPY POSITIVE
2. CYTOLOGY POSITIVE BUT
   - NEGATIVE FOR CYSTOSCOPY AND IMAGING
3. CYSTOSCOPY SUSPICIOUS FOR RECURRENCE POST INTRAVESICAL CHEMOTHERAPY; NO MORE THAN 2 CYCLES

Question 2

In cystoscopy positive patients, what are the two important steps for evaluation?

Answer 2

TURBT

and

Subsequent intravesical chemotherapy

Question 3

Is intravesical chemotherapy still performed in repeat TURBT in the context of posttreatment cTa, cT1, Tis recurrent or persistent cancer?

Answer 3

YES

Question 4

What agents are used in intravesical chemotherapy post repeat TURBT in the context of posttreatment cTa, cT1, Tis recurrent or persistent cancer?

Answer 4

GEMCITABINE AND MITOMYCIN

Question 5

In cystoscopy positive patients, what are the THREE treatment options, based on tumor stage and grade?

Answer 5

1. ADJUVANT INTRAVESICAL CHEMOTHERAPY
2. CYSTECTOMY
3. PEMBROLIZUMAB

Question 6

In cystoscopy positive patients posttreatment cTa, cT1, Tis recurrent or persistent cancer, when adjuvant intravesical therapy is chosen as an option, what are the indications?

Answer 6

BASED ON PROBABILITY OF RECURRENCE AND PROGRESSION IN TO MUSCLE INVASIVE DISEASE SUCH AS

1. SIZE
2. NUMBER
3. GRADE

Question 7

In cystoscopy positive patients posttreatment cTa, cT1, Tis recurrent or persistent cancer, when the patient is not a cystectomy candidate and recurrence is cTa or cT1, what are the TWO OPTIONS available?

Answer 7

1. CLINICAL TRIAL
2. CHEMORADIOTHERAPY

Question 8

In cystoscopy positive patients posttreatment cTa, cT1, Tis recurrent or persistent cancer, what are the SIX CONDITIONS to give Pembrolizumab?

Answer 8

1. BCG UNRESPONSIVE
2. HIGH RISK
3. NMIBC WITH Tis
4. with or without Ta
5. NON CYSTECTOMY CANDIDATE
6. DOES NOT PREFER CYSTECTOMY

Question 9

For patients whose cystoscopy is suspicious for recurrence post-intravesical therapy (no more than 2 consecutive cycles), what will you do for evaluation?

Answer 9

TURBT

IMMEDIATE INTRAVESICAL CHEMOTHERAPY

Question 10

For patients whose cystoscopy is suspicious for recurrence post-intravesical therapy (no more than 2 consecutive cycles) WITH NO RESIDUAL DISEASE, what PREFERRED treatment option is available?

Answer 10

IF PRIOR BCG TREATMENT, MAINTENANCE BCG

Question 11

For patients whose cystoscopy is suspicious for recurrence post-intravesical therapy (no more than 2 consecutive cycles), who turns out to have cTa, cT1, or Tis, what are the THREE OPTIONS available?

Answer 11

CYSTECTOMY FOR T1 (PREFERRED)

PEMBROLIZUMAB

CHANGE INTRAVESICAL CHEMOTHERAPY TO VALRUBICIN

Question 12

For patients whose cystoscopy is suspicious for recurrence post-intravesical therapy (no more than 2 consecutive cycles), who turns out to have cT1 disease, what is the PREFERRED CATEGORY 1 TREATMENT OPTION?

Answer 12

CYSTECTOMY IS CATEGORY 1

Question 13

For patients whose cystoscopy is suspicious for recurrence post-intravesical therapy (no more than 2 consecutive cycles), a change intravesical agent is a treatment option, which intravesical agent would you recommend?

Answer 13

VALRUBICIN

Question 14

VALRUBICIN is approved for which disease entity?

Answer 14

BCG REFRACTORY CIS

Question 15

For CYTOLOGY POSITIVE, imaging negative, cystoscopy negative patients, post initial TURBT suspected of having recurrent or persistent disease, what are the FOUR evaluation options available?

Answer 15

1. CYTOLOGY OF THE UPPER TRACTS
2. URETEROSCOPY
3. SELECTED MAPPING BIOPSIES INCLUDING TRANSURETHRAL BIOPSY OF THE PROSTATE
4. ENHANCED CYSTOSCOPY

Question 16

In doing enhanced cystoscopy, which is considered the current standard in the evaluation and staging of bladder cancer?

Answer 16

WHITE LIGHT CYSTSOCOPY

Question 17

Which type of cancer is white light cystoscopy sensitive for?

Answer 17

PAPILLARY CANCER

Question 18

In blue light cystoscopy, absorption of the photosensitizing drug into the urothelial cytoplasm is utilized to detect malignant cells. What color does malignant cells fluoresce with in the presence of blue light.

Answer 18

RED

Question 19

What are the TWO photosensitizers used in in blue light cystoscopy?

Answer 19

5ALA

HAL

Question 20

Narrow band imaging uses bands of light at 415 nanometers and 540 nanometers that are absorbed by what?

Answer 20

HEMOGLOBIN

Question 21

NBI is plagued an increased rate of?

Answer 21

FALSE POSITIVES

Question 22

For CYTOLOGY POSITIVE, imaging negative, cystoscopy negative patients post initial TURBT suspected of having recurrent or persistent disease, initial evaluation turned out to be NEGATIVE for bladder, prostate, and upper tracts, what are the TWO options?

Answer 22

1. FOLLOW UP AT 3 MONTHS THEN AT LONGER INTERVALS
2. IF WITH PRIOR BCG MAINTENANCE, MAINTENANCE BCG

Question 23

For CYTOLOGY POSITIVE, imaging negative, cystoscopy negative patients post initial TURBT suspected of having recurrent or persistent disease, the bladder turns out to be positive for disease. What are the THREE TREATMENT OPTIONS?

Answer 23

1. BCG
2. IF BCG UNRESPSONSVE:CYSTECTOMY
3. IF BCG UNRESPONSIVE: PEMBROLIZUMAB

Question 24

For CYTOLOGY POSITIVE, imaging negative, cystoscopy negative patients post initial TURBT suspected of having recurrent or persistent disease, the bladder turns out to be positive for disease. BCG regimen was instituted and showed no evidence of disease thereafter, what would you recommend next?

Answer 24

MAINTENANCE BCG

Question 25

For CYTOLOGY POSITIVE, imaging negative, cystoscopy negative patients post initial TURBT suspected of having recurrent or persistent disease, the bladder turns out to be positive for disease, BCG regimen was instituted and showed persistent and recurrent disease after, what are the THREE treatment options?

Answer 25

1. CYSTECTOMY 2. PEMBROLIZUMAB 3. CHANGE INTRAVESICAL THERAPY TO VALRUBICIN

Question 26

For CYTOLOGY POSITIVE, imaging negative, cystoscopy negative patients post initial TURBT suspected of having recurrent or persistent disease, the bladder turns out to be positive for disease, BCG regimen was instituted and showed persistent and recurrent disease after, valrubicin was chosen to be instilled but still showed an incomplete response. What are the two options you can offer your patient?

Answer 26

1. CYSTECTOMY 2. PEMBROLIZUMAB

Question 27

For CYTOLOGY POSITIVE, imaging negative, cystoscopy negative patients post initial TURBT suspected of having recurrent or persistent disease, the bladder turns out to be positive for disease. The patient was BCG-unresponsive, what are the TWO options you can give your patient?

Answer 27

1. CYSTECTOMY 2. PEMBROLIZUMAB