EAU-ESMO Consensus Statements on the Management of Advanced and Variant Bladder Cancer-An International Collaborative Multistakeholder Effort Under the Auspices of the EAU-ESMO Guidelines Committees

J. Alfred Witjes*, Marek Babjuk, Joaquim Bellmunt, H. Maxim Bruins, Theo M. De Reijke, Maria De Santis, Silke Gillessen, Nicholas James, Steven Maclennan, Juan Palou, Tom Powles, Maria J. Ribal, Shahrokh F. Shariat, Theo Van der Kwast, Evanguelos Xylinas, Neeraj Agarwal, Tom Arends, Aristotle Bamias, Alison Birtle, Peter C. BlackBernard H. Bochner, Michel Bolla, Joost L. Boormans, Alberto Bossi, Alberto Briganti, Iris Brummelhuis, Max Burger, Daniel Castellano, Richard Cathomas, Arturo Chiti, Ananya Choudhury, Eva Comperat, Simon Crabb, Stephane Culine, Berardino De Bari, Willem De Blok, Pieter J. L. De Visschere, Karel Decaestecker, Konstantinos Dimitropoulos, Jose L. Dominguez-Escrig, Stefano Fanti, Valerie Fonteyne, Mark Frydenberg, Jurgen J. Futterer, Georgios Gakis, Bogdan Geavlete, Paolo Gontero, Bernhard Grubmueller, Shaista Hafeez, Rob Jones, A. M. Leliveld-Kors

*Corresponding author for this work

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    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 prior to 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), and 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 statements, 33 (28%) achieved level 1 consensus and 49 (42%) 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 when further evidence is available to guide our approach. Patient summary: This report summarises findings from an international, multistakeholder project organised by the EAU and ESMO. In this project, a steering committee identified areas of bladder cancer management where there is currently no good-quality evidence to guide treatment decisions. From this, they developed a series of proposed statements, 71 of which achieved consensus by a large group of experts in the field of bladder cancer. It is anticipated that these statements will provide further guidance to health care professionals and could help improve patient outcomes until a time when good-quality evidence is available.

    Original languageEnglish
    Pages (from-to)223-250
    Number of pages28
    JournalEuropean Urology
    Issue number2
    Publication statusPublished - 1-Feb-2020


    • Bladder cancer
    • Consensus
    • Delphi
    • Diagnosis
    • Treatment
    • Follow-up

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