Diagnosis and treatment of superficial bladder cancer: an update

It is expected that approximately 50,500 new cases of bladder cancer will be diagnosed in 1995. In addition, approximately 10,000 people are expected to die of this disease during the year. An 11% increase in incidence observed from 1957 to 1987 was accompanied by a 19.4% decrease in the death rate in American males. This rate change may be attributable to stage migration to more localized disease as well as increased survival owing to improved treatment. Transurethral resection is standard first-line treatment for transitional cell carcinoma of the bladder. Intravesical therapy with cytotoxic agents or immunomodulators has become an important element in the management of patients with superficial bladder cancer at risk for disease recurrence and progression. Study results confirm the efficacy of both mitomycin and bacille Calmette-Guérin when administered intravesically. Comparative studies of these two agents are warranted to further clarify their respective roles in the prophylaxis of recurrences of superficial bladder cancer. Studies should enroll large numbers of patients, particularly those with high-grade lesions at significant risk of recurrence and progression. Current research involves evaluation methods of optimizing the efficacy of intravesical chemotherapy. High drug concentrations, hyperthermia, and combination modalities are a few new avenues being studied. In addition, new drugs like bropirimine, interferons, mycobacteria-associated antigens, and keyhole-limpet hemocyanin are being explored.