Current Insights in the Treatment of Superficial Transitional Cell Carcinoma of the Bladder

Abstract

Patients with superficial transitional cell carcinoma of the bladder (Ta, Tl, Tis) can nowadays be subdivided in different risk groups for tumor recurrence and progression, based on prognostic factors, which have been obtained from the results of clinical Phase III trials. For adjuvant therapy a choice can be made between intravesical instillations with chemotherapeutic or immunotherapeutic agents. The optimal treatment schedule and time to start intravesical therapy is not known. None of the investigated chemotherapeutic agents turned out to be superior in delaying tumor recurrence. Intravesical immunotherapy, using bacillus Calmette Guérin (BCG), seems to be as effective and maybe superior in high-risk groups in delaying tumor recurrence compared to chemotherapeutic agents. The side effects, however, are a disadvantage. The exact working mechanism of BCG and its antitumor effect is not known. In the field of recognizing patients at risk for recurrence or progressive disease, biological markers have been identified. In daily practice these markers cannot be used yet. Using all these different treatment options, it is important to obtain information on the impact of these treatment schedules on the quality of life, especially if the treatment results do not differ. A start has been made to imply questionnaires in superficial bladder cancer studies.