[Therapy selection in patients with advanced bladder cancer. Is molecular biology helpful?]

The prognosis of patients with advanced bladder cancer is still limited by a high rate of systemic progression. In addition to extended lymph node dissection, perioperative chemotherapy has been shown to improve the outcome after cystectomy. The role of neoadjuvant and adjuvant therapies are still a matter of controversial debate: there is an overtreatment of patients on the one hand but other patients are undertreated and do not receive chemotherapy because the progression risk may be underestimated on the basis of clinical and histopathological parameters. Improved cure rates can be achieved by new biomarkers defining the individual risk of systemic progression and predicting the response probability of the individual patient.A number of recent publications demonstrated that molecular signatures of the primary tumor can define the metastatic risk or correlate with chemotherapy response. Furthermore, it is essential to understand resistance mechanisms and to develop new targeted therapies based on knowledge of bladder tumor biology. This paper gives an overview concerning the role of molecular biology for therapy decision-making.