Can bladder preservation therapy come to the center stage?

Area of Science:

• Uro-oncology
• Surgical oncology
• Radiation oncology

Background:

• Multidisciplinary decision-making is crucial in urological cancer care.
• Management of urothelial carcinoma of the bladder has seen limited updates over 30 years, barring new immunotherapy for advanced cases.
• Radical cystectomy is the current standard for muscle-invasive bladder cancer.

Purpose of the Study:

• To review and compare outcomes of bladder preservation techniques for urothelial carcinoma of the bladder.
• To identify factors contributing to outcome variations in bladder preservation studies.
• To highlight the growing emphasis on bladder preservation in current treatment principles.

Main Methods:

• Review of existing literature on bladder preservation techniques for urothelial carcinoma of the bladder.
• Comparison of primary outcomes across different treatment modalities.
• Analysis of variance in study results for bladder preservation therapies.

Main Results:

• Trimodal therapy (chemotherapy, radiotherapy, transurethral resection) is a viable bladder-sparing alternative.
• Patient selection is key for successful organ-sparing approaches.
• Evidence from randomized trials comparing bladder preservation to surgery is limited.

Conclusions:

• Bladder preservation, including trimodal therapy, is increasingly emphasized for selected muscle-invasive bladder cancer patients.
• Shared decision-making regarding treatment options, including organ-sparing therapies, is essential.
• Further research is needed to solidify the role of bladder preservation against radical cystectomy.