[Therapy, follow-up treatment and prevention of urinary bladder cancer]

Bladder carcinoma is a disease with a poor prognosis if the tumor is of advanced stage: the 3-year survival rate in stage T3 and T4 is 21 and 4%, respectively. Superficial, noninfiltrating lesions, i.e., TA and T1 (82% 3-year survival rate), have a considerably more favorable prognosis, but on the other hand are associated with considerable morbidity. Recurrent tumors can be expected in 50-90%, and more than five transurethral resections are necessary in 12.7% of the cases. Treatment modalities as directed by tumor stage and grade should be as radical as possible, although preservation of proper bladder function as a factor of quality of life must be taken into consideration. In stage, T1, TUR is the treatment of choice. Thereafter, prophylactic topical administration of intravesical chemotherapy is successful in the prevention of recurrencies. In cases of less differentiated tumors usually associated with deeper infiltration (T3) and if random biopsies reveal carcinoma in situ, radical surgery is indicated. Partial bladder resection for a solitary tumor may be successful only, when rigid limitations of the indication are kept in mind. A radical cystectomy is the treatment of choice in stage T3 with deep muscle invasion; for this tumor category, preoperative radiotherapy offers the best overall results. Single definitive radiotherapy is less effective as if combined with surgery and has a recurrency rate of 41-56%. In metastatic carcinoma (T4, N+, M1), only palliative therapy is possible, with a goal of improving life quality without essentially lengthening survival.