Swedish national guidelines on urothelial carcinoma: 2024 update on advanced and metastatic disease

Authors

  • Anders Ullén Department of Pelvic Cancer, Genitourinary Oncology and Urology Unit, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden; Department of Oncology and Pathology, Karolinska Institute, Stockholm, Sweden
  • Firas Aljabery Department of Clinical and Experimental Medicine, Division of Urology, Linköping University, Linköping, Sweden
  • Pär Dahlman Department of Radiology, Uppsala Akademiska Hospital, Uppsala, Sweden
  • Karin Falkman Department of Urology, Södersjukhuset, Stockholm, Sweden
  • Truls Gårdmark Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
  • Tomas Jerlström Department of Urology, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
  • Susanna Holst Department of Medical Imaging and Physiology, Skåne University Hospital, Malmö, Sweden
  • Sofia Kjellström Department of Oncology, Skåne University Hospital, Malmö, Sweden
  • Anna-Karin Lind Department of Urology, Skåne University Hospital, Malmö, Sweden; Institution of Translational Medicine, Lund University, Malmö, Sweden
  • Dimitrios Papantoniou Department of Oncology, Ryhov County Hospital, Jönköping, Sweden
  • Jonas Stenlund Department of Urology, Umeå University, Umeå, Sweden
  • Viveka Ströck Department of Urology, Sahlgrenska University Hospital, Göteborg, Sweden; Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
  • Karin Söderkvist Department of Diagnostics and Intervention, Onkology, Umeå University, Umeå, Sweden
  • Helena Thulin Department of Pelvic Cancer, Genitourinary Oncology and Urology Unit, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden; Department of Oncology and Pathology, Karolinska Institute, Stockholm, Sweden
  • Elin Trägårdh Department of Medical Imaging and Physiology, Skåne University Hospital, Malmö, Sweden; Institution of Translational Medicine, Lund University, Malmö, Sweden
  • Ingrida Verbiene Department of Oncology, Uppsala Akademiska Hospital, Uppsala, Sweden
  • Jonas Wallström Department of Radiology, Sahlgrenska University Hospital, Göteborg, Sweden
  • Elisabeth Öfverholm Department of Oncology, Sahlgrenska University Hospital, Göteborg, Sweden
  • Fredrik Liedberg Department of Urology, Skåne University Hospital, Malmö, Sweden; Institution of Translational Medicine, Lund University, Malmö, Sweden

DOI:

https://doi.org/10.2340/sju.v60.43236

Keywords:

Bladder cancer, guidelines, advanced, metastatic

Abstract

Objective: To overview and summarise the Swedish National Guidelines on Urothelial Carcinoma 2024.

Methods: A narrative review of the updated guidelines was performed, highlighting new treatment recommendations for advanced and metastasized disease. 

Results: Compared to the previous guideline version, the current update includes recommendations for standardised radiological reporting when urothelial carcinomas are detected at CT-urography (CTU), to early identify locally advanced patients and accelerate the care pathway for these patients. The Swedish guidelines apply a more structured and liberal recommendation for the use of 18F-fluorodeoxyglucose-positron emission tomography/computed tomography in patients with locally advanced urothelial carcinomas compared to the EAU-guidelines and recommend such examinations prior to transurethral resection. Improved outcomes for radical cystectomy in Sweden after centralised cystectomy care have led to a recommendation for performing more than six nephroureterectomies (NUs) per year for upper tract urothelial carcinomas (UTUC)-based associations with decreased use of invasive diagnostic modalities and better survival outcomes. Additionally, updated recommendations regarding adjuvant systemic therapies for muscle-invasive disease have been included. Whilst awaiting national regulatory approval for enfortumab vedotin/pembrolizumab, the present guideline version aligns with EAU-guidelines by endorsing cisplatin-gemcitabine-nivolumab as a new first-line treatment option in cisplatin-fit patients with unresectable or metastatic urothelial carcinoma.

Conclusions: The current version of the Swedish national guidelines on urothelial carcinoma introduces standardised reporting at CTU to facilitate early identification of advanced disease, includes recommendations for centralisation of NU for UTUC and updated recommendations for adjuvant systemic treatment of muscle-invasive disease and endorses cisplatin-gemcitabine-nivolumab as a new first-line treatment option for non-resectable locally advanced and metastatic disease.

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2025-03-25

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Ullén, A., Aljabery, F., Dahlman, P., Falkman, K., Gårdmark, T., Jerlström, T., … Liedberg, F. (2025). Swedish national guidelines on urothelial carcinoma: 2024 update on advanced and metastatic disease. Scandinavian Journal of Urology, 60, 76–82. https://doi.org/10.2340/sju.v60.43236

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Vol. 60 (2025)

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Copyright (c) 2025 Anders Ullén, Firas Aljabery, Pär Dahlman, Karin Falkman, Truls Gårdmark, Tomas Jerlström, Susanna Holst, Sofia Kjellström, Anna-Karin Lind, Dimitrios Papantoniou, Jonas Stenlund, Viveka Ströck, Karin Söderkvist, Helena Thulin, Elin Trägårdh, Ingrida Verbiene, Jonas Wallström, Fredrik Liedberg, Elisabeth Öfverholm

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As from Volume 59 (2024) all published articles, unless otherwise specified, are published under CC-BY license, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, with the condition of proper attribution to the original work. 

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