Recent advancements in the diagnosis and treatment of non‐muscle invasive bladder cancer: Evidence update of surgical concept, risk stratification, and BCG‐treated disease

Abstract

In the management of non‐muscle invasive bladder cancer (NMIBC), disease progression and long‐term control are determined by the intensity of delivered treatment and surveillance and the cancer cells' biological nature. This requires risk stratification–based postoperative management, such as intravesical instillation of chemotherapy drugs, Bacillus Calmette–Guérin (BCG), and radical cystectomy. Advancements in mechanical engineering, molecular biology, and surgical skills have evolved the clinical management of NMIBC. In this review, we describe the updated evidence and perspectives regarding the following aspects: (1) advancements in surgical concepts, techniques, and devices for transurethral resection of the bladder tumor; (2) advancements in risk stratification tools for NMIBC; and (3) advancements in treatment strategies for BCG‐treated NMIBC. Repeat transurethral resection, en‐bloc transurethral resection, and enhanced tumor visualization, including photodynamic diagnosis and narrow‐band imaging, help reduce residual cancer cells, provide accurate diagnosis and staging, and sensitive detection, which are the first essential steps for cancer cure. Risk stratification should always be updated and improved because the treatment strategy changes over time. The BCG‐treated disease concept has recently diversified to include BCG failure, resistance, refractory, unresponsiveness, exposure, and intolerance. A BCG‐unresponsive disease is an extremely aggressive subset unlikely to respond to a rechallenge with BCG. Numerous ongoing clinical trials aim to develop a future bladder‐sparing approach for very high‐risk BCG‐naïve NMIBC and BCG‐unresponsive NMIBC. The key to improving the quality of patient care lies in the continuous efforts to overcome the clinical limitations of bedside management.

Hub biomarkers in ultrasound-guided bladder cancer and osteosarcoma: Myosin light chain kinase and caldesmon

“…[ 13 , 14 ] Individuals with bladder cancer may face emotional stress, anxiety, and depression, in addition to challenges related to work, family, and social life. [ 15 , 16 ] Treatment of osteosarcoma typically requires surgical intervention, which may involve tumor resection and the removal of affected bone tissue. [ 17 ] In some cases, amputation may be necessary, posing significant physical and psychological challenges to patients.…”

Differences in oncological benefits from second transurethral resection between white‐light initial surgery and photodynamic diagnosis‐guided initial surgery for primary high‐risk non‐muscle invasive bladder cancer

“…Whether PDD‐TURBT was performed or not depended on situation of trials which were ongoing at that time, physicians' choice, and patients' preference. Patients were stratified into four groups based on the clinicopathological findings at the initial TURBT (according to the 2019 Japanese Urological Association guidelines) as low‐risk, intermediate‐risk, high‐risk, and highest‐risk according to the clinicopathological data obtained by the initial TURBT, not considering those obtained by second TUR 15 . The patients who underwent immediate cystectomy for primary high‐risk NMIBC were excluded from analysis.…”

“…Sankey diagrams were used to illustrate the pathological pathway using R version 4.2.0 (packages: tidyverse, survival; https://www.r-project.org/). 15 …”

Investigating the impact of regulatory B cells and regulatory B cell-related genes on bladder cancer progression and immunotherapeutic sensitivity

“…Bladder cancer (BLCA) is ranked as the 10th most prevalent cancer globally, with approximately 573,000 new cases and 213,000 deaths [ 1 , 2 ]. According to reports from the World Health Organization, the incidence of BLCA is projected to double by 2040 [ 3 ].…”