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Urothelial carcinoma of the bladder: definition, treatment and future efforts

Nature Reviews Urology volume 8, pages 631–642 (2011)Cite this article

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Abstract

The identification of patients with high-risk bladder cancer is important for the timely and appropriate treatment of this lethal disease. The understanding of the natural history of bladder cancer has improved; however, the criteria used to define high-risk disease and the relevant treatment strategies have remained the same for the past several decades, despite multiple large, randomized, prospective clinical trials that have evaluated the use of intravesical, surgical and systemic therapies. The genetic signature of high-risk bladder cancer has been a focus of investigation and has led to the discovery of potential molecular targets for disease identification, risk stratification and therapy. These advances, combined with a comprehensive risk assessment profile that incorporates available pathological and clinical characteristics, might improve the diagnosis and treatment of patients with bladder cancer.

Key Points

  • Bladder cancer is clinically heterogeneous and characterized by non-muscle-invasive lesions that recur frequently, but are generally not associated with mortality, and aggressive muscle-invasive lesions associated with poor outcomes

  • The disease follows two divergent clinical paths—high-risk and low-risk urothelial carcinoma of the bladder—that are derived from a distinct genetic and molecular background

  • The optimal schedules and durations for intravesical and systemic immunotherapy and chemotherapy remain unknown; in the future, the most effective strategies will probably incorporate pharmacogenomics and targeted therapies

  • Pelvic lymphadenectomy during radical cystectomy and perioperative chemotherapy are currently underused in the clinic

  • Optimal treatment decisions must incorporate both clinical and pathological findings

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Figure 1: Asymmetric thickening of the bladder wall (arrow) on T2-weighted MRI.
Figure 2: Example of muscle-invasive, extravesical disease on CT.

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Acknowledgements

D. Lie, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the Medscape, LLC-accredited continuing medical education activity associated with this article.

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  1. Section of Urology, University of Chicago Medical Center, 5841 South Maryland Avenue, MC 6038, Chicago, 60637, IL, USA

    Sandip M. Prasad & Gary D. Steinberg

  2. Department of Urology, Columbia University Medical Center, 5141 Broadway Avenue, Third Floor, New York, 10034, NY, USA

    G. Joel DeCastro

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S. M. Prasad and G. J. DeCastro contributed equally to writing the article, researching data for the article, discussion of content and editing the manuscript before submission. G. D. Steinberg contributed to researching data for the article, discussion of content and editing the manuscript before submission.

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G. D. Steinberg is a consultant for Abbott Molecular, Endo Pharmaceuticals and Tengion. The other authors declare no competing interests.

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Prasad, S., DeCastro, G. & Steinberg, G. Urothelial carcinoma of the bladder: definition, treatment and future efforts. Nat Rev Urol 8, 631–642 (2011). https://doi.org/10.1038/nrurol.2011.144

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