ABSTRACT Background Standard management of
muscle-invasive
bladder cancer involves
radical cystectomy with pelvic
lymph node dissection. However,
patients may be ineligible for
surgery or may wish to avoid the
morbidity of
cystectomy due to
quality of life concerns.
Bladder preservation
therapies have emerged as alternatives
treatment options that can provide comparable oncologic outcomes while maintaining
patients'
quality of life. Objective To
review bladder preservation
therapies,
patient selection criteria, and functional and oncologic outcomes for BPT in
muscle-invasive
bladder cancer. Materials and
Methods We conducted a comprehensive
literature review of
bladder preservation
therapies in
Pubmed and Embase. Discussion The ideal
patient for BPT has low-volume T2
disease, absence of CIS, absence of
hydronephrosis, and a maximal TURBT with regular
surveillance.
Technological advancements involving
cancer staging, TURBT
technique, and
chemotherapy and
radiation therapy regimens have improved BPT outcomes, with oncologic outcomes now comparable to those of
radical cystectomy. Advancements in BPT also includes a heightened focus on improving
quality of life for
patients undergoing
bladder preservation. Preservation
strategies with most evidence for use include trimodality
therapy and
partial cystectomy with pelvic
lymph node dissection. Conclusions This
review highlights the breadth of
strategies that aim to preserve a
patient's
bladder while still optimizing local
tumor control and overall
survival.
Future areas for innovation include the use of predictive
biomarkers and implementation of
immunotherapy, moving the field towards
patient-tailored care.