From the Guidelines
The prognosis for stage two bladder cancer is generally favorable, with a 5-year survival rate of approximately 63-70%. At this stage, the cancer has invaded the muscle layer of the bladder wall but has not spread to nearby lymph nodes or distant sites.
Treatment Options
Treatment typically involves:
- Radical cystectomy (complete removal of the bladder) with urinary diversion, often preceded by neoadjuvant chemotherapy using regimens like dose-dense MVAC (methotrexate, vinblastine, doxorubicin, and cisplatin) or gemcitabine plus cisplatin for 3-4 cycles 1.
- For patients who wish to preserve their bladder or cannot undergo surgery, a bladder-sparing approach combining maximal transurethral resection, radiation therapy, and concurrent chemotherapy (typically cisplatin) may be an option 1.
Follow-Up
Regular follow-up is essential after treatment, including:
- Cystoscopy
- Urine cytology
- Imaging studies every 3-6 months initially, then less frequently over time 1.
Prognostic Factors
The prognosis improves significantly when the cancer is completely removed and no microscopic disease remains. Factors that may affect prognosis include:
- The patient's age
- Overall health
- Response to treatment
- Specific characteristics of the tumor 1.
Key Considerations
Radical cystectomy is the standard treatment for patients with muscle-invasive bladder cancer, and bladder-preserving approaches are reasonable alternatives for patients who are medically unfit for surgery or seek an alternative 1. Two large randomized trials and a meta-analysis support the use of neo-adjuvant chemotherapy before cystectomy for T2 and T3 disease, with a demonstrated survival benefit of 5% at 5 years 1.
From the Research
Prognosis of Stage Two Bladder Cancer
The prognosis of stage two bladder cancer is influenced by various factors, including the effectiveness of treatment and the presence of certain characteristics such as variant histology and hydronephrosis.
- Treatment options for stage two bladder cancer include transurethral resection of bladder tumor (TURBT) followed by intravesical chemotherapy or Bacillus Calmette-Guérin (BCG) instillation, as well as radical cystectomy or trimodal treatment with TURBT, radiotherapy, and chemotherapy 2, 3.
- A complete TURBT prior to neoadjuvant chemotherapy has been associated with improved survival and oncologic outcomes in patients with muscle-invasive bladder cancer, with higher 5-year overall and cancer-specific survival rates 4.
- The use of novel technologies such as photodynamic diagnosis and bipolar electrocautery may help improve the diagnostic accuracy and reduce the recurrence rate of non-muscle-invasive bladder cancer 5.
- Adjuvant therapy with mitomycin C or BCG instillation after TURBT has been shown to decrease the recurrence rate of superficial bladder cancer, with no significant difference between the two treatments 3.
Factors Influencing Prognosis
Several factors can influence the prognosis of stage two bladder cancer, including:
- The completeness of TURBT, with complete resection associated with improved outcomes 4
- The presence of variant histology, which may be associated with a higher risk of recurrence and progression 4
- The presence of hydronephrosis, which may be associated with a higher risk of recurrence and progression 4
- The response to neoadjuvant chemotherapy, with a pathologic complete response associated with improved outcomes 4
Treatment Outcomes
The outcomes of treatment for stage two bladder cancer can vary depending on the specific treatment approach and the individual patient's characteristics.
- Overall, the 5-year survival rate for patients with stage two bladder cancer is around 77% for those with complete TURBT prior to neoadjuvant chemotherapy, and 46% for those without complete TURBT 4.
- The recurrence rate can be decreased with the use of adjuvant therapy such as mitomycin C or BCG instillation after TURBT 3.
- The progression rate can be influenced by factors such as the presence of variant histology and hydronephrosis, and the effectiveness of treatment 4, 3.