Management of superficial and muscle-invasive urothelial cancers of the bladder.

PURPOSE OF REVIEW: To summarize recent developments and controversies in the management of both nonmuscle-invasive and muscle-invasive urothelial carcinoma of the bladder. RECENT
FINDINGS: Bladder cancer remains a commonly diagnosed disease both within the United States and worldwide. Despite improvements in diagnosis and management of nonmuscle-invasive bladder tumors, the risk of both recurrence and progression remains significant. Tobacco use remains the single most common modifiable causative factor and there is recent evidence to suggest the favorable effect of urologist involvement in tobacco cessation. While radical cystectomy remains the mainstay of treatment for muscle-invasive disease, there is a growing body of evidence supporting the use of minimally invasive radical cystectomy. Ongoing randomized studies will improve our understanding of the comparative effectiveness and harms of both minimally invasive cystectomy as well as the optimal extent of pelvic lymphadenectomy at the time of radical cystectomy.
SUMMARY: Bladder cancer remains a complex and heterogeneous disease. Careful attention to risk stratification of patients with nonmuscle-invasive tumors permits appropriate timing of intravesical therapy and radical cystectomy. Ongoing efforts to improve the quality of data surrounding the comparative effectiveness and harms of interventions for both nonmuscle-invasive and muscle-invasive disease will enhance our ability to predict which treatments work in which patients, and under what circumstances and at what cost.