Application of clinical trials to the care of patients with bladder cancer.

Abstract

Patients with bladder cancer are fortunate because much of the treatment they receive is based on the findings of randomized clinical trials that ensure a sound, scientific basis for the treatment decisions they will agree with their urologist. Patients with Ta or T1 transitional cell carcinoma will be distressed to learn their diagnosis but will be comforted to know that they are most unlikely to die of the disease. They will be well advised to have at least one instillation of intravesical chemotherapy and if they are confirmed to have a good-prognosis tumour, they will probably need only annual follow-up cystoscopies. Other patients will have to accept the inconvenience of more frequent cystoscopies. Should they develop multiple superficial recurrences, more intensive intravesical chemotherapy or BCG is effective. This should probably be repeated at 6-monthly intervals for up to 3 years, although the optimum duration of treatment and the best treatment regimens require further clarification. Patients with muscle invasive bladder cancer do not have a good prognosis and, unfortunately, the addition of systemic chemotherapy does not offer any clear survival advantage at the present time. New, more effective forms of treatment are awaited. The confidence with which bladder cancer patients can be treated is based on the results of collaborative, multicentre trials that have been conducted over the past two decades. The important lesson to be learned, by physician and patient alike, is that randomized clinical trials are worthwhile because the results influence clinical practice and assure best possible care.