Bladder Cancer in Males: A Comprehensive Review of Urothelial Carcinoma of the Bladder

Abstract

Bladder cancer is the second most common genitourinary malignancy after prostate cancer. It is a disease most commonly encountered in the elderly, particularly males, and has several well-established risk factors, including smoking and occupational exposures to certain chemical carcinogens. Roughly 90% of all bladder cancers are urothelial in origin; that is, they arise from the epithelial lining of the bladder. The remainder, including squamous cell carcinoma and adenocarcincoma, are nonurothelial. This review will focus solely on bladder cancer of urothelial origin, commonly referred to as urothelial carcinoma (UC) of the bladder. Bladder cancer can be divided into three distinct clinical entities: nonmuscle-invasive bladder cancer (NMIBC), muscle-invasive bladder cancer (MIBC), and metastatic bladder cancer. Each entity calls for different management. NMIBC, which accounts for roughly 70% of bladder cancer diagnoses, usually can be managed with transurethral resection, intravesical chemotherapy/immunotherapy, and aggressive surveillance protocols to monitor for recurrence and progression. MIBC calls for radical cystectomy (RC) with urinary diversion and bilateral pelvic lymph node dissection. Although it is often underutilized, neoadjuvant chemotherapy with platinum-based regimens improves survival. Data on adjuvant chemotherapy are less robust, but it remains an option for those who are medically fit and considered to be at high risk for recurrence and progression. Bladder-preserving strategies, including partial cystectomy and trimodality therapy, can provide adequate cancer control in appropriately selected patients with MIBC. Stringent surveillance is required. Metastatic bladder cancer is often lethal and the standard of care remains platinum-based chemotherapy regimens. Renal insufficiency is a common comorbidity that prevents patients from receiving chemotherapy in all settings. Currently, there are no recommended second-line chemotherapy regimens. Given the high rate of recurrence and progression, better prognostic variables should help to identify those who should be targeted in clinical trials. As bladder cancer affects a large number of men every year and significantly contributes to healthcare expenditures, prompt diagnosis and appropriate management are critical.