• 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 Black, Bernard H Bochner, Michel Bolla, Joost L Boormans, Alberto Bossi, Alberto Briganti, Iris Brummelhuis, Max Burger, Daniel Castellano, Richard Cathomas, Arturo Chiti, Ananya Choudhury, Eva Compérat, 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 Grubmüller, Shaista Hafeez, Donna E Hansel, Arndt Hartmann, Dickon Hayne, Ann M Henry, Virginia Hernandez, Harry Herr, Ken Herrmann, Peter Hoskin, Jorge Huguet, Barbara A Jereczek-Fossa, Rob Jones, Ashish M Kamat, Vincent Khoo, Anne E Kiltie, Susanne Krege, Sylvain Ladoire, Pedro C Lara, Annemarie Leliveld, Estefania Linares-Espinós, Vibeke Løgager, Anja Lorch, Yohann Loriot, Richard Meijer, M Carmen Mir, Marco Moschini, Hugh Mostafid, Arndt-Christian Müller, Christoph R Müller, James N'Dow, Andrea Necchi, Yann Neuzillet, Jorg R Oddens, Jan Oldenburg, Susanne Osanto, J G Oyen Wim W Department of Biomedical Sciences, Humanitas University, Milan, Italy; Humanitas Research Hospital, Milan, Italy; Department of Radiology and Nuclear Medic, Luís Pacheco-Figueiredo, Helle Pappot, Manish I Patel, Bradley R Pieters, Karin Plass, Mesut Remzi, Margitta Retz, Jonathan Richenberg, Michael Rink, Florian Roghmann, Jonathan E Rosenberg, Morgan Rouprêt, Olivier Rouvière, Carl Salembier, Antti Salminen, Paul Sargos, Shomik Sengupta, Amir Sherif, Robert J Smeenk, Anita Smits, Arnulf Stenzl, George N Thalmann, Bertrand Tombal, Baris Turkbey, Susanne Vahr Lauridsen, Riccardo Valdagni, Antoine G Van Der Heijden, Hein Van Poppel, Mihai D Vartolomei, Erik Veskimäe, Antoni Vilaseca, Franklin A Vives Rivera, Thomas Wiegel, Peter Wiklund, Andrew Williams, Richard Zigeuner, and Alan Horwich.
• Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands. Electronic address: Fred.Witjes@radboudumc.nl.
• Eur. Urol. 2020 Feb 1; 77 (2): 223-250.

BackgroundAlthough guidelines exist for advanced and variant bladder cancer management, evidence is limited/conflicting in some areas and the optimal approach remains controversial.ObjectiveTo bring together a large multidisciplinary group of experts to develop consensus statements on controversial topics in bladder cancer management.DesignA 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.SettingOnline Delphi survey and consensus conference.ParticipantsThe European Association of Urology (EAU), the European Society for Medical Oncology (ESMO), experts in bladder cancer management.Outcome Measurements And Statistical AnalysisStatements 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 LimitationsOverall, 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.ConclusionsThese 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 SummaryThis 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.Copyright © 2019 European Society of Medical Oncology and European Association of Urology. Published by Elsevier B.V. All rights reserved.

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