Advances in bladder cancer.

Intravesical chemotherapy and immunotherapy are administered to patients with bladder cancer in the hope of decreasing the rate of recurrence and, more importantly, reducing the rate of progression. So far, bacille Calmette-Guérin is the only agent to decrease progression rate and thus increase survival. Bacille Calmette-Guérin has been shown to achieve this outcome by selectively sparing certain sequences during fibronectin degradation; these critical fragments were shown to have motility-stimulating activity, which may then enhance tumor invasion. In vivo and in vitro studies have shown that cathepsin B inhibitors prevent degradation of human basement membrane laminin, which is the first step of tumor invasion. Cathepsin B inhibitors either alone or in combination with bacille Calmette-Guérin may be valuable in preventing the progression of superficial bladder tumors in the future. Clinical studies on bacille Calmette-Guérin have repeatedly shown that a second course of bacille Calmette-Guérin to patients with local failure did not jeopardize patient survival. Adjuvant chemotherapy for patients with locally advanced disease and for those with regionally involved lymph nodes improves progression-free survival. Further controlled studies will establish the verdict for adjuvant chemotherapy. With the advancement of molecular genetic studies relevant to modern technology, our understanding of tumor behavior improves dramatically, and classic knowledge becomes more outdated every day.