Journal: BJU international
The article reviews bladder-sparing strategies for muscle-invasive bladder cancer (MIBC), focusing on trimodality therapy (TMT) as the key alternative to radical cystectomy (RC).
RC as the historical standard
- RC remains the historical standard but carries high morbidity and notable 90‑day mortality.
- RC has substantial long‑term quality‑of‑life (QoL) impact.
Trimodality therapy (TMT)
- TMT is now guideline‑accepted for appropriately selected patients.
- TMT consists of maximal transurethral resection (TURBT) followed by concurrent chemoradiotherapy with radiosensitising agents.
Other bladder-preserving strategies
- TURBT alone may be an option in select circumstances.
- TURBT followed by systemic therapy with surveillance in patients achieving a complete clinical response may also be considered.
- However, supporting evidence for these approaches is more limited.
Surveillance and outcomes
- Surveillance is critical after any bladder-sparing approach to detect recurrences early and enable timely salvage RC.
- Salvage RC is required in roughly 11–16% of contemporary TMT cohorts.
- QoL outcomes generally favour TMT over RC, especially for urinary and sexual function.
- Severe treatment-related toxicity with TMT is uncommon, with grade ≥3 adverse events in under 10% of patients.
Overall conclusion
Overall, in carefully selected MIBC patients, bladder-sparing approaches—particularly TMT—offer a viable alternative to RC when integrated into multidisciplinary care with a commitment to lifelong surveillance.