Bladder preservation in the treatment of muscle-invasive bladder cancer

Abstract

Organ preserving strategies are being increasingly utilized in the treatment of solid malignancies with the intent of reducing surgical morbidity and maintaining quality of life. Organ preservation becomes a viable approach only when cancer outcomes are not compromised when compared to radical resection. We reviewed the current literature on bladder preservation for muscle-invasive bladder cancer, focusing on trimodality therapy consisting of complete transurethral resection, radiation therapy, and chemotherapy. Acknowledging the absence of randomized clinical trials, differences in patient selection, and variation in study protocols, trimodality therapy may yield similar 5-and 10-year overall survival rates compared to radical cystectomy alone. This includes the approximately 30% of patients who enter a bladder preservation protocol and undergo salvage radical cystectomy for failure of local control. Currently, bladder preservation appears to be an alternative to radical cystectomy in select patients who have appropriate rigorous surveillance.

Potential therapeutic strategies for non - muscle invasive bladder cancer based on association of intravesical immunotherapy with P-MAPA and systemic administration of cisplatin and doxorubicin

“…For treatment of invasive bladder cancer using a combination of TURBT, radiation therapy, and systemic chemotherapy-trimodality bladder preservation therapy-has been proposed and used in the last years for treatment of carefully selected patients ( 17 ). Also, the National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology for Bladder Cancer and the International Consultation on Urological Diseases-European Association of Urology recognized the trimodality preservation bladder therapy as an alternative to radical cystectomy for patients with MIBC who are noncystectomy candidates and for those that are motivated to keep their native bladders ( 18 ).…”