Therapy of superficial bladder cancer

Abstract

Intravesical therapy is used in the management of superficial transitional cell carcinoma of the urinary bladder (i.e. Ta, T1, and carcinoma in situ) with specific objectives, including treating existing or residual tumor, preventing recurrence of tumor, preventing progression of disease, and prolonging survival. The initial clinical stage and grade remain the main determinant factors in survival, irrespective of the treatment. Involvement of prostatic urethral mucosa with bladder cancer can be effectively treated with bacillus Calmette-Guerin intravesical immunotherapy. Results of current investigations suggest that biologic and molecular markers might be useful in monitoring the outcome of intravesical therapy. Intravesical chemotherapy has demonstrated a reduction in short-term tumor recurrence rates, but has had no positive impact on disease progression or prolongation of survival. Bacillus Calmette-Guerin immunotherapy remains the most effective treatment and prophylaxis for transitional cell carcinoma, with a positive impact on tumor recurrence rate, disease progression, and prolongation of survival. Interferons, keyhole limpet hemocyanin and Photofrin-mediated photodynamic therapy are under investigation in the management of transitional cell carcinoma and the efficacy results are encouraging. This review summarizes the recent advances in intravesical therapy and prophylaxis of transitional cell carcinoma and the important role of intravesical immunotherapy.