[Bladder Preservation Therapy for Bladder Cancer].

Abstract

Bladder cancer is classified into non-muscle-invasive bladder cancer(NMIBC)and muscle-invasive bladder cancer(MIBC).The prognosis for patients with NMIBC is generally favorable, and initial treatment for NMIBC typically involves transurethral resection of bladder tumor(TURBT), along with bladder instillation therapy based on risk stratification, with the goal of controlling the cancer while preserving the bladder. For cases at high risk of recurrence or progression, Bacillus Calmette-Guérin(BCG)intravesical therapy is used to prevent these events and ultimately avoid radical cystectomy. However, some patients exhibit BCG-unresponsive disease, defined as high-grade cancer persisting or recurring early after adequate BCG treatment. For BCG-unresponsive NMIBC, radical cystectomy is typically considered. However, recent advances are focused on the development of novel treatments aimed at bladder preservation in this patient population, offering hope for further progress in the future. The standard treatment for MIBC is radical cystectomy, but there is a certain number of patients who are either unfit for or unwilling to undergo this procedure. Addressing treatment options for these patients remains a significant unmet need. Recently, bladder preservation therapies using a multimodal approach, including trimodality therapy, have emerged as potential treatment options for MIBC. Appropriate patient selection, as well as further refinement and standardization of treatment protocols, remain key challenges.