Staged based directed surveillance of invasive bladder cancer following radical cystectomy: valuable and effective?

Excerpt

Radical cystectomy with pelvic lymphadenectomy remains the optimal treatment for muscle invasive bladder cancer curing the majority of patients with organ confined tumors (stage pT1-2), but only a minority of those with low-volume node positive (N1) disease or with locally advanced (stage pT3b-4), and rarely those with extensive node-positive (N2-3), or metastatic (M+) bladder cancer [ 1‐7 ]. Approximately 50% of patients will suffer a distant recurrence following surgery, most (80–90%) within 24 months of surgery with the most common sites being lung, liver, and osseous [ 6‐12 ]. Studies consistently show the risk of both local and distant recurrence increases with advancing pathologic stage and nodal burden of disease, whereas recurrences following chemotherapy for metastatic disease seem to have a predilection for prior sites of disease with the brain serving as a sanctuary site for delayed relapse [6‐12]. The risk of urothelial recurrences in the upper tract or remnant urethra are also predictable and related to pretreatment clinical factors such as the presence of multifocal disease, diffuse carcinoma in situ, distal ureteral or intramural tunnel involvement, or prior disease involvement of the upper tracts or prostatic urethra [13‐18]. …