The Japanese Urological Association (JUA) has previously published ‘General Rules for Clinical and Pathological Studies on Bladder Cancer’, with several revisions, but this is the first edition of their Clinical Guidelines for the Management of Bladder Cancer.
Internationally, a number of guidelines related to bladder cancer have been published, including those by the National Comprehensive Cancer Network (NCCN), the National Cancer Institute (NCI), Physician Data Query (PDQ), the American Urological Association (AUA), and the European Association of Urology (EAU). The diagnosis, classification and treatment of bladder cancer in Japan have been conducted in accordance with the JUA ‘General Rule’, based on the overseas guidelines. However, it has been pointed out that the recommended options based on overseas guidelines and other references are not always suitable for Japanese clinical practice, with some medications and therapeutic equipment not licensed for use in Japan. As the reader will understand after referring to the reference list for these Guidelines, a relatively large number of clinical trials has been conducted in Japan in the field of bladder cancer, and hence the JUA considered it appropriate to formulate their own guidelines.
In general, when formulating clinical guidelines, it is normal to classify disease according to patient risk. The tumor-nodes-metastasis classification (TNM) and American Joint Committee on Cancer (AJCC) classifications are widely used worldwide, but a number of different, more detailed, classifications of risk have been proposed internationally, with no general consensus at present. For example, it would be rather pointless to propose one's own risk classification of non-muscle-invasive bladder cancer (NMIBC), based on Western guidelines, without sufficient clinical trial data for support. The challenge for us now is to produce a new risk classification based on a meta-analysis of the results of multiple clinical trials. The risk classifications contained in the clinical questions (CQ) and their answers in these Guidelines will therefore differ somewhat from the references on which they are based. However, we have followed the general worldwide consensus for NMIBC, recommending that the low-risk group receive one instillation of chemotherapy, the intermediate-risk group receive multiple instillations of chemotherapy or bacillus calmette-guérin (BCG), and the high-risk group receive either intravesical BCG immunotherapy or total cystectomy.
These Guidelines present an overview of bladder cancer at each clinical stage, followed by CQ that address problems frequently faced in everyday clinical practice. We tried to provide as broad an exposition of each CQ topic as possible, and refer to as many related areas as we could, but considering the nature of these Guidelines it is extremely difficult to cover every specific circumstance in a satisfactory manner. In the future, we plan to revise these Guidelines at appropriate intervals, incorporating the opinions of specialists working in the field, adding new medications as they come to light, and adding data from relevant clinical trials.
In this abridged English version, due to space constraints, we have abridged each overview, and summarized each CQ and its answer. We have included only those references we considered of particular importance. The reference numbers have been changed to be consecutive for the English version, and will differ from the original Guidelines.