Non-muscle Invasive Bladder Cancer: Identifying Patients to Consider Timely, Initial Cystectomy
Journal Title: The Bulletin of Urooncology - Year 2020, Vol 19, Issue 4
Abstract
Non-muscle invasive bladder cancer is a heterogeneous disease with widely varying risks of recurrence and progression to muscle invasion. Risk stratification within current treatment guidelines are an attempt to address this heterogeneity. This heterogeneity stems from a number of pathologic characteristics as well as recurrence status. Radical cystectomy, while the definitive, curative therapy for muscle invasive disease, is not often utilized for non-muscle invasive disease, even when it may be a superior option to bladder-sparing therapy. A majority of American Urologists have been reported to defer cystectomy for less invasive therapies when it is a guideline driven option. Both cystectomy and bladder-sparing therapy have excellent oncologic outcomes, but very different morbidity and mortality profiles. Timely, initial cystectomy provides improved oncologic outcomes for patients with high-risk non-muscle invasive bladder cancer, as opposed to delayed cystectomy following prolonged, failed bladder-sparing therapy. Patient selection is paramount when considering timely, initial cystectomy, given the increased rates of morbidity and mortality. The heterogeneity of non-muscle invasive pathologic characteristics includes a number of factors that may help differentiate patients who would benefit from a timely, initial cystectomy as opposed to bladder-sparing therapy. A rapidly evolving understanding of bladder cancer biology may help improve risk stratification and further aid in the selection of patients for timely, initial cystectomy.
Authors and Affiliations
George E. Koch, Sam S. Chang
Keywords
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- EP ID EP691633
- DOI 10.4274/uob.galenos.2020.1549
- Views 118
- Downloads 0
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