Management of muscle-invasive bladder cancer: an update.

The aim of this Review is to critically assess the currently used methods for the treatment of muscle-invasive bladder cancer. Radical cystectomy seems to be the gold standard for the treatment of bladder cancer, and the optimum extent of lymph-node dissection has now been identified. An early cystectomy should be carried out once a diagnosis of muscle invasion is established. Preoperative radiation is no longer popular, but could be due a reassessment in view of technical advances. Results of neoadjuvant and adjuvant chemotherapy trials are subject to criticism. Most trials are retrospective, used different chemotherapy protocols and did not have uniform end point assessment. Bladder-preservation strategies can offer cures for a selection of subpopulations, but these patient groups have yet to be clearly defined. Developments in molecular biology are exciting, and their potential application is pending translational research. To be meaningful and useful, future trials that involve additional or alternative modalities should be prospective, randomized and adequately powered.