Recent advances in the management of superficial bladder tumors

Superficial bladder tumors are by far the most common form of bladder cancer managed by practicing urologists. Indeed up to 75% of initial tumors fall in this category and because of the high recurrence rate, superficial tumors represent over 90% of tumor events being treated. New diagnostic methods have been developed to improve the sensitivity of tumor detection of both cystoscopy and urinary cytology. Risk stratification of patients based on simple clinical parameters provides new opportunities for adapting monitoring strategies as well as providing a rationale for the use of intravesical chemotherapy and immunotherapy. Finally, recent pathological substratification of stage T1 grade 3 may allow a stepwise approach to the management of this high risk tumor. Collectively, all these advances bring us a stepforward in tailoring the management of superficial bladder tumor patients by minimizing the burden of unnecessary investigations and treatments while safely identifying those patients with high risk disease that deserve more aggressive treatment.