Radical Cystectomy is the best choice for most patients with muscle-invasive bladder cancer? Opinion: No

Bladder Cancer and Debate on Trimodal Therapy (Tmt) for Bladder Preservation

“…The gold standard treatment for Invasive Bladder Cancer is still the Radical Cystectomy (RC), but using Neoadjuvant Chemotherapy before the surgical procedure. [1][2][3][4][5][6][7] The Transurethral Bladder Tumor Resection (TUBTR) gives prognosis, is diagnostic and often therapeutic in some circumstances, but after an initial TUR, many patients (34% to 76%) will have residual disease present due to non-resection of the tumor in its entirety, increasing the risk of recurrence and progression. 1 In non-invasive tumor, the minimum goal of bladder cancer treatment is to eliminate the tumor, prevent disease recurrence and a possible progression to invasive muscle disease.…”

“…1 For invasive muscle tumor, RC is still the standard gold treatment, performing the radical surgical procedure as soon as possible, since the delay of this approach implies a lower survival due to the progression of the disease with the presence of micrometastases. [1][2][3][4][5][6][7] Hospitals that perform a high volume of radical cystectomies have lower mortality rates and complications than low volume centers. 1 In men, the standard RC is the removal of the bladder, prostate, vesicles Seminal and distal ureters, where as in women, RC removes bladder, urethra, vagina, uterus and ureters.…”

“…2,3,8 Organ preservation therapies have been developed as an alternative to radical treatments for cancer diseases located in organs. 7 The debate is whether this therapy can achieve the same survival rates that are obtained with radical cystectomy; however, because of the lack of long-term randomized studies, this comparison is still unknown. 1,4,7 When the bladder is to be preserved, the treatment of invasive tumor is performed with Trimodal Therapy (TMT), which determines a surgical approach with radical TUR, radiotherapy and chemotherapy, selecting well the patients who should undergo this therapeutic line for a correct comparative study with the other therapies.…”

“…7 The debate is whether this therapy can achieve the same survival rates that are obtained with radical cystectomy; however, because of the lack of long-term randomized studies, this comparison is still unknown. 1,4,7 When the bladder is to be preserved, the treatment of invasive tumor is performed with Trimodal Therapy (TMT), which determines a surgical approach with radical TUR, radiotherapy and chemotherapy, selecting well the patients who should undergo this therapeutic line for a correct comparative study with the other therapies. 3,4,6,7,8 Patients with tumor-related hydronephrosis, flat lesions such as CIS, locally advanced disease (T4), presence of urethral obstruction and lymph node involvement are poor candidates for preservation of the bladder and are generally excluded from TMT.…”

“…1,4,7 When the bladder is to be preserved, the treatment of invasive tumor is performed with Trimodal Therapy (TMT), which determines a surgical approach with radical TUR, radiotherapy and chemotherapy, selecting well the patients who should undergo this therapeutic line for a correct comparative study with the other therapies. 3,4,6,7,8 Patients with tumor-related hydronephrosis, flat lesions such as CIS, locally advanced disease (T4), presence of urethral obstruction and lymph node involvement are poor candidates for preservation of the bladder and are generally excluded from TMT. 3,4 Tumors eligible for preservation of the bladder are those with low volume T2 disease without hydronephrosis, CIS; Single tumors less than three centimeters and of usual histology; And patients who can't or don't want to undergo RC.…”