Vol. 46 (2): 169-184, March – April, 2020
Judy Hamad 1, Hannah McCloskey 2, Matthew I. Milowsky 3, Trevor Royce 4, Angela Smith 5
1 University of North Carolina at Chapel Hill School of Medicine; Chapel Hill, NC, USA; 2 Department of Urology, University of North Carolina at Chapel Hill; Chapel Hill, NC, USA; 3 Department of Medicine, Division of Hematology/Oncology, University of North Carolina at Chapel Hill; Chapel Hill, NC, USA; 4 Department of Radiation Oncology, University of North Carolina at Chapel Hill; Chapel Hill, NC, USA; 5 Department of Urology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill; Chapel Hill, NC, USA
Background: Standard management of muscle-invasive bladder cancer involves radi-cal cystectomy with pelvic lymph node dissection. However, patients may be ineligible for surgery or may wish to avoid the morbidity of cystectomy due to quality of life concerns. Bladder preservation therapies have emerged as alternatives treatment op-tions that can provide comparable oncologic outcomes while maintaining patients’ quality of life.
Objective: To review bladder preservation therapies, patient selection criteria, and func- tional and oncologic outcomes for BPT in muscle-invasive bladder cancer. Materials and Methods: We conducted a comprehensive literature review of bladder preservation therapies in Pubmed and Embase.
Discussion: The ideal patient for BPT has low-volume T2 disease, absence of CIS, ab-sence of hydronephrosis, and a maximal TURBT with regular surveillance. Technologi- cal advancements involving cancer staging, TURBT technique, and chemotherapy and radiation therapy regimens have improved BPT outcomes, with oncologic outcomes now comparable to those of radical cystectomy. Advancements in BPT also includes a heightened focus on improving quality of life for patients undergoing bladder preser-vation. Preservation strategies with most evidence for use include trimodality therapy and partial cystectomy with pelvic lymph node dissection.
Conclusions: This review highlights the breadth of strategies that aim to preserve a patient’s bladder while still optimizing local tumor control and overall survival. Future areas for innovation include the use of predictive biomarkers and implementation of immunotherapy, moving the fi eld towards patient-tailored care.
Keywords: Urinary Bladder Neoplasms; Therapeutics; Cystectomy