Bladder-Sparing Treatments

This chapter deals with various bladder-sparing treatments: (1) Radical transurethral resection of the bladder tumor (TURBT) can be a feasible option in selected muscle-invasive bladder cancer patients. Endoscopic complete tumor removal and subsequent determination of completeness of TURBT, either via restaging TURBT or concomitant biopsies of the tumor bed, should be achieved. (2) Partial cystectomy for the treatment of muscle-invasive bladder cancer has historically been maligned after several series reported high recurrence rates and poor oncologic outcomes. Partial cystectomy can be offered as an equally effective alternative to radical cystectomy in highly selected patients. (3) Bladder preservation strategies are considered effective methods with the potential to replace radical cystectomy for selected MIBC patients. One such bladder preservation strategy, chemotherapy, is generally not recommended as the only treatment method. To achieve complete response to treatment while maintaining bladder structure and function, it is important for urologists, medical oncologists, and radiation oncologists to cooperatively administer multimodal treatments. (4) Organ conservation approaches have become the standard of care for numerous malignancies. During the past three decades, prospective clinical trials have established that bladder preservation therapy for select patients with MIBC is a safe and effective alternative to radical cystectomy. Trimodality therapy offers an effective alternative to cystectomy that could bridge this wide gap in care for bladder cancer patients.