Recurrent or aggressive bladder cancer. Indications for adjuvant intravesical therapy.

Advances in understanding of the variables that adversely affect the prognosis of patients with superficial bladder cancer allow more accurate predictions of the aggressive biologic potential of tumors. Intravesical therapy appears to be an effective and essential adjuvant in those patients with high-risk tumor variables. Multiple risk factors related to the tumor, individual patient characteristics, and treatment modality must be evaluated. Assignment of the relative importance of these risk factors will differ from patient to patient. Factors useful for predicting tumor aggressiveness in order to decide the appropriateness of adjuvant intravesical therapy include tumor size, configuration, and grade; ploidy status; Tis and T1 categories; multifocality; postoperative cytologic analysis; the failure of prior intravesical therapy; and prostatic urethral involvement. The integration of this information with formulation of a treatment plan represents both the art and the science of urologic oncologic practice. Research efforts need to be directed at the development of better tumor markers for superficial bladder cancer.