Active surveillance for nonmuscle invasive bladder cancer

Abstract

Nonmuscle invasive bladder cancer (NMIBC) is known to be a heterogeneous malignancy that requires varying treatment modalities and follow-up schedules. Low-grade Ta papillary tumors are categorized as low-risk NMIBC because of their favorable prognosis. There is an expanding movement that overdiagnosis and overtreatment should be avoided considering the economic impact and the patients' quality of life. It has been over 10 years since the initial assessment of active surveillance for low-risk NMIBC suggested its feasibility and safety. However, urologists are still unfamiliar with this treatment option, which can be ideal in appropriately selected patients. In this review article, we focus on active surveillance for low-risk NMIBC and discuss the evidence and rationale for this treatment option. There are several issues to resolve in order to advocate active surveillance as a standard option in selected patients. A specific follow-up protocol including intervals of cystoscopy, urine cytology, urine markers, and other radiographic examinations need to be optimized and validated. Finally, we integrate the available data into the follow-up strategy and propose a new surveillance protocol for active surveillance of recurrent low-risk bladder cancer.

Intravesical treatment of chemotherapeutic agents sensitizes bacillus Calmette‑Guerin by the modulation of the tumor immune environment

“…Approximately 75% of UCB cases are diagnosed as non-muscle invasive bladder cancer (NMIBC) consisting of tumors staged as Ta, T1 and carcinoma in situ (3). Transurethral resection of the bladder tumor, followed by the administration of adjuvant intravesical treatment with bacillus Calmette-Guerin (BCG) or chemotherapeutic agents such as mitomycin C (MMC) and adriamycin (ADM), is the gold-standard treatment for NMIBC (4). Despite improved management for decreasing the recurrence rate and prolonging the progression-free interval, NMIBC exhibits significant potential of recurrence intravesically and progression to muscle-invasive bladder cancer (5,6).…”

Regulatory T Cells and Tumor-Associated Macrophages in the Tumor Microenvironment in Non-Muscle Invasive Bladder Cancer Treated with Intravesical Bacille Calmette-Guérin: A Long-Term Follow-Up Study of a Japanese Cohort

“…Urothelial carcinoma (UC) of the bladder is a heterogeneous disease in terms of its clinical and biological aspects [ 1 ]. Among non-muscle invasive bladder cancer (NMIBC) patients, several factors such as age, T category, tumor grade, tumor size, and multiplicity are recognized to predict the risk of intravesical recurrence and progression after transurethral resection of bladder tumor (TURBT) [ 2 , 3 ].…”

Outcomes of subsequent non‐muscle‐invasive bladder cancer treated with intravesical Bacillus Calmette‐Guérin after radical nephroureterectomy for upper urinary tract urothelial carcinoma

“…Intravesical instillation of bacillus calmette‐guerin (BCG) is a standard treatment for carcinoma in situ (CIS) and an adjuvant option for T1 and higher grade Ta bladder tumours after transurethral resection of bladder tumour (TURBT) . Evidence from studies on primary non‐muscle‐invasive bladder cancer (NMIBC) has led to risk stratification and treatment guidelines for primary NMIBC ; however, little is known about subsequent NMIBC after RNU for primary UTUC (hereafter referred to as UTUC‐NMIBC). Although bladder UC and UTUC have many similarities, there are several anatomical, biological and molecular differences that warrant consideration of these conditions as two distinct urothelium‐derived malignancies .…”