Can bladder preservation therapy come to the center stage?

• Published in: International journal of urology Vol. 25; no. 2; pp. 134 - 140
• Main Authors: Inamoto, Teruo, Ibuki, Naokazu, Komura, Kazumasa, Juri, Hiroshi, Yamamoto, Kiyohito, Yamamoto, Kazuhiro, Fujita, Kazutoshi, Nonomura, Norio, Narumi, Yoshifumi, Azuma, Haruhito
• Format: Journal Article
• Language: English
• Published: Australia Wiley Subscription Services, Inc 01.02.2018
• Subjects: Bladder cancer; bladder preservation; Cancer therapies; Chemotherapy; Decision making; Immune checkpoint; Invasiveness; Metastases; muscle‐invasive bladder cancer; Platinum; Preservation; prognosis; Radiation therapy; Surgery; Urinary bladder; Urothelial carcinoma; bladder preservation; muscle-invasive bladder cancer; prognosis
• DOI: 10.1111/iju.13495
• ISSN: 0919-8172

Decision‐making in urological cancer care requires a multidisciplinary approach for refinement, but its impact on urothelial carcinoma of the bladder has not been fully addressed for the past three decades, except for the latest immunological checkpoint inhibitor approved by the U.S. Food and Drug Administration for metastatic muscle‐invasive bladder cancer that is resistant to platinum‐based chemotherapy. For the time being, radical cystectomy is the gold standard of curative therapy for muscle‐invasive bladder cancer. Trimodal therapy that combines chemotherapy for the purpose of radiation sensitization, external beam radiotherapy and transurethral resection of bladder tumor has emerged as a potential alternative treatment option that preserves the bladder. In lack of randomized studies for bladder preservation therapy compared with surgery, the principles of management of urothelial carcinoma of the bladder have evolved in recent times, with an emphasis on bladder preservation. A number of bladder preservation techniques are available to the surgeon; however, appropriately selected patients with muscle‐invasive bladder cancer should be offered the opportunity to discuss various treatment options, including organ‐sparing trimodal therapy. The aim of the present study was to compare the primary outcomes of the available treatment methods and identify the sources of variance among studies. A review of various bladder preservation techniques in vogue for the management of urothelial carcinoma of the bladder is discussed.