Strategies to prevent progression of high-risk bladder cancer at initial diagnosis

As high-risk nonmuscle invasive bladder cancer (NMIBC) has a high propensity to recur and progress, the primary therapeutic goal in patients with high-risk NMIBC is the prevention or delay of disease recurrence and progression.

For improving transurethral resection quality, new optical enhancement technology such as optical coherence tomography, photodynamic diagnosis and narrow band imaging might be considered because these emerging optical techniques may contribute to resection completeness and reduce the recurrence risk. Recent studies have confirmed that a second resection is associated with a lower risk of progression and cancer-related death. Although maintenance bacillus Calmette-Guérin (BCG) for at least 1 year has been recommended, some studies have shown no significant advantage to maintenance BCG. Although other options may be considered in early BCG failure, there are no large trials that have shown a long-term benefit in BCG-failure patients.

Current literature suggests that the best treatment for patients with high-risk NMIBC involves complete transurethral resection with intravesical BCG therapy. New approaches or therapeutic agents for preventing recurrence and progression are needed in this field.