SUPERFICIAL BLADDER CANCER

UPDATE TREATMENT

Abstract

The management of superficial bladder cancer should be based on a careful assessment of cancer
histopathology (grade, stage, size and number), previous history of bladder cancer (number & timing of recurrences) and patient/physician preference. Patients with favorable tumor profiles at the initial diagnosis do not require intravesical therapy. Alternatively, a single intravesical administration of chemotherapy may be performed following TUR. Patients with favorable tumor characteristics that recur with similar features may be best treated with intravesical chemotherapy. The induction regimen should consist of 6+3 instillation scheme. Patients failing a single 6-week course of BCG may respond to a second 6 week course. Those patients with significant risk of disease progression (high grade, T1 with/without CIS) should be managed with caution. Although such patients are candidates for early cystectomy, they are also candidates for intravesical BCG. Patients treated with BCG intravesical chemotherapy for high-grade superficial bladder cancer are at significant long-term risk for disease recurrence, progression and even death from disease. Careful and vigilant follow-up is necessary for life in these patients. The urologist must be extremely active and diligent when treating with superficial bladder cancer. An understanding of tumor biology and current intravesical therapies is important to appropriately treat these patients. Furthermore, and perhaps most important, the timely decision to abandon conservative therapy and proceed with radical cystectomy and urinary diversion should be kept in mind to prevent the potentially lethal sequelae of intravesical cancer.