Intravesical therapy in superficial bladder cancer
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J A Witjes1, P F Mulders, F M Debruyne
1Department of Urology, University Hospital, Nijmegen, The Netherlands.
Objective:
To identify the appropriate characteristics of superficial bladder cancer that allow the physician to predict tumor behavior.
Methods:
We analyzed 1,745 patients with primary superficial bladder cancer with regard to disease and patient characteristics.
Results:
With the characteristics we found, the population can be described and prognostic factors can be found. Moreover, with the use of these factors, it appears to be possible to predict tumor behavior on a group level. Prediction on an individual level, however, remains far from ideal.
Conclusions:
Three treatment options can be chosen: follow-up after initial transurethral resection, additional instillations with intravesical chemotherapy, or instillations with bacillus Calmette-Guerin (BCG). In case instillations are indicated, most (but not all) superficial bladder cancer trials show superiority of BCG over intravesical chemotherapy, although at the cost of more side effects. However, with intravesical BCG, it seems possible to influence the natural history of superficial bladder cancer, which means that we can delay progression and improve survival.