Setting the stage for bladder preservation

Area of Science:

• Urology
• Oncology
• Radiation Oncology

Background:

• Muscle-invasive bladder cancer (MIBC) often leads to radical cystectomy.
• Potentially curative bladder-preservation treatments for MIBC are underutilized.
• Trimodality therapy (TMT) offers an alternative to cystectomy for select MIBC patients.

Purpose of the Study:

• To highlight the efficacy and benefits of trimodality bladder-preservation therapy for muscle-invasive bladder cancer.
• To emphasize TMT as a viable and guideline-supported alternative to cystectomy.
• To discuss future directions for optimizing TMT and patient selection.

Main Methods:

• Review of cumulative data from prospective clinical trials and large institutional series on TMT for MIBC.
• Analysis of long-term outcomes, including bladder function, toxicity, and quality of life.
• Discussion of multidisciplinary approaches and the role of biomarkers.

Main Results:

• Trimodality therapy (TMT) is established as a safe and effective alternative to upfront cystectomy for select MIBC patients.
• The majority of long-term TMT survivors retain functional bladders with good quality of life and low toxicity.
• TMT is recognized as an accepted option in numerous clinical guidelines for MIBC.

Conclusions:

• Trimodality therapy (TMT) effectively preserves the bladder in select muscle-invasive bladder cancer patients, offering a safe alternative to cystectomy.
• Optimizing systemic therapy and identifying predictive biomarkers can further enhance TMT outcomes.
• Multidisciplinary collaboration is crucial for optimal TMT delivery, research, and patient-centered decision-making.