Bladder preservation in muscle-invasive bladder cancer: a comprehensive review

Abstract

Background: Standard management of muscle-invasive bladder cancer involves radical cystectomy with pelvic lymph node dissection. However, patients may be ineligible for surgery or may wish to avoid the morbidity of cystectomy due to quality of life concerns. Bladder preservation therapies have emerged as alternatives treatment options that can provide comparable oncologic outcomes while maintaining patients' quality of life. Objective: To review bladder preservation therapies, patient selection criteria, and functional and oncologic outcomes for BPT in muscle-invasive bladder cancer. Materials and Methods: We conducted a comprehensive literature review of bladder preservation therapies in Pubmed and Embase. Discussion: The ideal patient for BPT has low-volume T2 disease, absence of CIS, absence of hydronephrosis, and a maximal TURBT with regular surveillance. Technological advancements involving cancer staging, TURBT technique, and chemotherapy and radiation therapy regimens have improved BPT outcomes, with oncologic outcomes now comparable to those of radical cystectomy. Advancements in BPT also includes a heightened focus on improving quality of life for patients undergoing bladder preservation. Preservation strategies with most evidence for use include trimodality therapy and partial cystectomy with pelvic lymph node dissection. Conclusions: This review highlights the breadth of strategies that aim to preserve a patient's bladder while still optimizing local tumor control and overall survival. Future areas for innovation include the use of predictive biomarkers and implementation of immunotherapy, moving the fi eld towards patient-tailored care.

Giant bladder stone with squamous cell carcinoma of bladder: Case report and the literature review

“…Bladder preservation therapy can be an alternative treatment option while maintaining the patient's quality of life. The ideal criteria for bladder preservation therapy including: solitary mass, low volume, stage of T2 or below, absence of carcinoma in situ, no hydronephrosis, and maximal resection with routine surveillance [ 10 ]. Additional therapeutic modalities such as chemotherapy and radiation therapy regimens may improve bladder preservation therapy outcomes [ 10 ].…”

“…So, we still considering the radical cystectomy procedure, while conducting adjuvant chemotherapy (gemcitabine/cisplatin), and strict monitoring. The comprehensive review from Hamad et al [ 10 ], states that patient refusal is one of the main factors in the decision of radical cystectomy, refers to the Southwest Oncology Group phase II trial which states that 45% of MIBC patients do not undergo radical cystectomy because of patient refusal, in addition to other causes such as: unresectable tumors (34%), and surgically or medically unfit (21%).…”

Increasing costs from bladder cancer in the Brazilian Health System: the role of establishing public health policies

“…Centralization programs have been proven to reduce costs and improve outcomes when treating BC (10). Creating reference centers is beneficial not only for the treatment of an individual patient but also for bringing these patients to centers where more strict protocols can be followed (11). New medications can be prescribed when they are beneficial, but judicialization tends to be lower in this setting (9).…”

Relationship of frailty with treatment modality selection in patients with muscle-invasive bladder cancer (FRART-BC study)

“…Relationship of frailty with treatment modality selection in patients with muscle-invasive bladder cancer (FRART-BC study) demonstrated comparable survival outcomes when patients were appropriately selected (7)(8)(9)(10)(11)(12)(13). However, no level 1 evidence supported the definitive selection criteria for TMT.…”