Alexander Kutikov, MD
The search for effective alternatives to radical cystectomy (RC) in patients with bladder cancer has lasted more than 3 decades. Progress has been slow, but investigators have proved that a combination of radiation, chemotherapy, and maximal transurethral resection of the bladder tumor (TURBT) works as well as RC in carefully selected patients. At least 2 trials are investigating the further possibility that patients whose tumors have certain genetic profiles might fare just as well with chemotherapy alone as they do with chemotherapy and RC. Other groups, moreover, are planning checkpoint inhibitor trials that might shed light on other ways to reduce the number of bladder removals.
“Cystectomy is a high-risk surgery, particularly for the frail and elderly, who are the most likely to get bladder cancer,” noted Alexander Kutikov, MD, chief of the Division of Urology and Urologic Oncology at Fox Chase Cancer Center in Philadelphia, Pennsylvania. “Even when the surgery goes well, it’s a life-changing event. You can have a high quality of life with a urinary diversion, but it’s challenging. Any advance that reduces the need for cystectomy is a significant advance, so it’s exciting that there are several promising alternatives in various trial stages.”
Bladder cancer is the sixth-most-common malignancy in the United States, with about 80,000 new diagnoses per year.1
The disease is typically diagnosed when blood in the urine sends patients to the doctor. About 70% of all bladder cancers are found before the tumor becomes muscle invasive or metastasizes.2
About 5% of all bladder cancers are already metastatic at the time of diagnosis.3
Cancers detected before they become muscle invasive are typically treated with TURBT and intravesical bacille Calmette-Guérin (BCG), a tuberculosis vaccine that spurs an immune attack on bladder cancer. This treatment is often curative. The 5-year survival rate for patients with stage 0 bladder cancer is 95.8%.4
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