Multidisciplinary management of patients with localized bladder cancer

Multidisciplinary approach to muscle-invasive bladder cancer is imperative to achieve optimal long-term cancer control. Radical cystectomy, pelvic lymph node dissection, and urinary diversion have been the mainstay of therapy for decades. Laparoscopic and robotic-assisted surgical techniques are becoming increasingly prevalent, and have shown short-term benefits in terms of blood loss, less pain, and smaller incisions. Neoadjuvant chemotherapy plus surgery results in absolute survival advantage and this approach is encouraged in appropriate patients. A similar survival advantage with the use of adjuvant chemotherapy has yet to be convincingly demonstrated. Bladder-preservation protocols involving a visibly complete transurethral resection followed by chemoradiation may be a feasible option for select patients.