Treatment of Muscle Invasive Urothelial Bladder Cancer- A Review of the Literature

Carcinoma of the bladder is the fourth and fifth most frequently diagnosed cancer in the United States and Europe respectively. Muscle-Invasive Urothelial Bladder Cancer (MIBC) (cT2-T4) is an aggressive disease with poor 5-year Overall Survival (OS) of 50%. Epidemiological studies are unavailable in most African countries; however, Africa was found to have a lower incidence. Current optimal management is based on Radical Cystectomy (RC) and pelvic Lymph Node Dissection (LND), generally associated with pre-operative cisplatin-based chemotherapy. Adjuvant chemotherapy may be necessary in patients who did not benefit from neoadjuvant chemotherapy. A selected few patients who desire bladder preservation may benefit from bladder sparing procedures but should be cautioned about the risk of recurrence. The African literature lacks structured prospective studies on the management of urothelial muscle invasive bladder cancer and much of the clinical data are extrapolated from current evidence-based guidelines.