From the Guidelines
The prognosis for bladder cancer varies significantly based on the stage at diagnosis, with early-stage cancers having excellent survival rates while advanced disease carries a poorer outlook, and treatment should follow a stage-based approach, prioritizing radical cystectomy with neoadjuvant chemotherapy for muscle-invasive disease, as recommended by the most recent guidelines 1.
Overview of Bladder Cancer Prognosis and Treatment
The prognosis and treatment of bladder cancer depend on the stage at diagnosis. Early-stage cancers have excellent survival rates, while advanced disease carries a poorer outlook. Treatment typically follows a stage-based approach.
- For non-muscle invasive bladder cancer (stages 0 and I), transurethral resection of bladder tumor (TURBT) is performed to remove visible tumors, often followed by intravesical therapy using BCG (Bacillus Calmette-Guérin) or chemotherapy drugs like mitomycin C instilled directly into the bladder.
- For muscle-invasive disease (stages II and III), radical cystectomy (complete bladder removal) with urinary diversion is standard, frequently combined with neoadjuvant chemotherapy using regimens like gemcitabine plus cisplatin for 3-4 cycles before surgery, as supported by recent guidelines 1.
- For metastatic bladder cancer (stage IV), systemic treatments include platinum-based chemotherapy, immunotherapy with PD-1/PD-L1 inhibitors (pembrolizumab, atezolizumab), and targeted therapies for specific genetic mutations.
Importance of Recent Guidelines
Recent guidelines, such as those published in 2022 1, emphasize the importance of a stage-based approach to treatment and highlight the role of neoadjuvant chemotherapy in improving outcomes for patients with muscle-invasive bladder cancer.
- These guidelines also stress the need for regular surveillance with cystoscopy, urine cytology, and imaging after treatment, as recurrence is common.
- Smoking cessation is crucial for all patients as it improves treatment outcomes and reduces recurrence risk.
Quality of Life Considerations
The goal of therapy for bladder cancer is not only to improve survival but also to maintain quality of life.
- Treatment decisions should take into account the patient's overall health, preferences, and values.
- Palliative care and supportive measures should be integrated into the treatment plan to address symptoms, pain, and other quality of life issues, as recommended by recent guidelines 1.
From the FDA Drug Label
The median duration of response, calculated from the Kaplan-Meier curve as median time to recurrence, is estimated at 4 years or greater. The incidence of cystectomy for 90 patients who achieved a complete response (CR or CRNC) was 11%. The median time to cystectomy in patients who achieved a complete response (CR or CRNC) exceeded 74 months The Kaplan-Meier estimates of 2-year disease-free survival are shown in Table 3. The difference in disease-free survival time between the 2 groups was statistically significant by the log rank test (P=0. 03).
The prognosis for bladder cancer patients treated with BCG (INH) is as follows:
- The median duration of response is estimated to be 4 years or greater.
- The incidence of cystectomy is 11% for patients who achieved a complete response.
- The median time to cystectomy exceeds 74 months for patients who achieved a complete response.
- The estimated 2-year disease-free survival is 57% for the TICE BCG arm and 45% for the MMC arm, with a statistically significant difference between the two groups. The treatment for bladder cancer includes intravesical administration of TICE BCG, with a treatment schedule consisting of induction and maintenance phases 2.
From the Research
Bladder Cancer Prognosis and Treatment
The prognosis and treatment for bladder cancer depend on various factors, including the stage and grade of the tumor, as well as the patient's overall health.
- Non-muscle invasive bladder cancer (NMIBC) is the most common type of bladder cancer, accounting for approximately 75% of all cases 3.
- The treatment for NMIBC typically involves transurethral resection of the bladder tumor (TURBT) followed by intravesical therapy, which involves the delivery of drugs directly into the bladder through a catheter 4, 5.
- Intravesical bacillus Calmette-Guérin (BCG) is a common treatment for NMIBC, and has been shown to be effective in reducing the risk of recurrence and progression 3, 5.
- However, some patients may not respond to BCG therapy, and alternative treatments are being explored, including novel intravesical therapies and systemic therapies such as immunotherapy 6, 7.
Treatment Options for Non-Muscle Invasive Bladder Cancer
- Low-risk NMIBC: Intravesical therapy is not usually considered for low-risk NMIBC, and treatment typically involves TURBT alone 6.
- Intermediate- and high-risk NMIBC: Intravesical BCG is the standard of care for intermediate- and high-risk NMIBC, but alternative approaches are being explored, including novel intravesical therapies and systemic therapies 4, 5, 6.
- BCG-unresponsive disease: Patients who do not respond to BCG therapy pose a challenging management dilemma, and alternative treatments are being explored, including second-line intravesical therapies and radical surgery 7.
Emerging Trends in Bladder Cancer Treatment
- Novel intravesical therapies: Several new intravesical therapies are being developed, including agents that target specific molecular pathways involved in bladder cancer 6, 7.
- Systemic therapies: Systemic therapies such as immunotherapy are being explored for the treatment of bladder cancer, particularly for patients with advanced disease 5, 6.
- Personalized medicine: The use of biomarkers and other diagnostic tools to tailor treatment to individual patients is an emerging trend in bladder cancer treatment 5, 6.