Recent studies in bladder cancer.

Abstract

The progression of carcinoma in situ of the bladder to invasive bladder carcinoma has been shown to be essentially regulated by p53 overexpression. In another study, however, loss of heterozygosity of chromosome 9 has also been shown to be essential for progression to muscle invasive disease. Routine random biopsies for predicting prognosis and deciding on adjuvant intravesical therapy should be abandoned because of the results of a well-designed trial on 1745 patients. The aforementioned study showed that the recurrence and progression rates could be only slightly improved at a cost of more intravesical therapy if random biopsies were done routinely. The survival of patients undergoing radical cystectomy was shown to be strongly affected by the primary tumor stage even in those patients with positive nodes. Radical cystectomy and lymph node dissection alone could be beneficial in node-positive patients if the tumor was confined to the bladder. Neoadjuvant chemotherapy and bladder sparing could be recommended only on selected patients with significant reduction in tumor size after chemotherapy. The response to adjuvant chemotherapy could be prolonged if consolidation surgical intervention is performed on responders. With the help of new prognostic parameters obtained from molecular genetic analysis, the already increasing survival trends in bladder carcinomas will hopefully continue to improve in the near future.