This review provides an overview of emerging techniques, namely, photodynamic diagnosis (PDD), narrow band imaging (NBI), Raman spectroscopy, optical coherence tomography, virtual cystoscopy, and endoscopic microscopy for its use in the diagnosis and surveillance of bladder cancer. The technology, clinical evidence and future applications of these approaches are discussed with particular emphasis on PDD and NBI. These approaches show promise to optimise cystoscopy and transurethral resection of bladder tumours.

Prashant Patel

Richard T. Bryan

D. Michael A. Wallace

Emerging Endoscopic and Photodynamic Techniques for Bladder Cancer Detection and Surveillance

A. Karim Kader

Bladder Cancer

Urothelial carcinoma is the fifth most common malignancy diagnosed each year in the United States. Neoadjuvant and adjuvant chemotherapy are given to decrease the risk of recurrent or metastatic disease with the more robust clinical data supporting the former. Bladder preservation utilizes a trimodality approach with maximal transurethral resection followed by concurrent chemotherapy and radiation and is appropriate for select patients. Gemcitabine and cisplatin is the current standard of care for first-line treatment in fit patients with metastatic disease. Optimal second-line therapy remains undefined, and targeted agents are under investigation. Clinical trial participation should be encouraged in patients with urothelial carcinoma of the bladder to help improve treatment regimens and outcomes. Synopsis. Chemotherapy is commonly used in the treatment of urothelial carcinoma of the bladder. This paper will review the role of chemotherapy in the neoadjuvant, adjuvant, bladder sparing, and metastatic settings.

Carrie Costantini

Frederick Millard

Update on Chemotherapy in the Treatment of Urothelial Carcinoma

Bladder cancer continues to be one of the most common malignancies. Those who have been already diagnosed are at high risk for recurrence, especially if the pathology demonstrates high-grade disease. Diagnosis and surveillance is reliant on invasive evaluation with cystoscopy. Urinary cytology has been used to aid in diagnosis, but its use is limited. Other assays have been developed that may aid in clinical decision making. The ultimate goal will be the development of a highly sensitive and specific urinary marker for bladder cancer. This would provide a noninvasive means of diagnosing the disease and limit the number of unnecessary cystoscopies. This article will review the currently available urinary bladder cancer markers. It will also review new and investigational urinary markers that have shown promise for future clinical use.

Justin Parker

Philippe E. Spiess

Current and Emerging Bladder Cancer Urinary Biomarkers

While open radical cystectomy remains the gold-standard treatment for muscle-invasive bladder cancer and high-risk non&#x2013;muscle invasive disease, robotic assisted radical cystectomy (RARC) has been gaining popularity over the past decade.  The robotic approach has the potential advantages of less intraoperative blood loss, shorter hospital stay, less post-operative narcotic requirement, quicker return of bowel function, and earlier convalescence with an acceptable surgical learning curve for surgeons adept at robotic radical prostatectomy.  While short to intermediate term oncologic results from several small RARC series are promising, bladder cancer remains a potentially lethal malignancy necessitating long-term follow-up.  This article aims to review the currently published literature, important technical aspects of the operation, oncologic and functional outcomes, and the future direction of RARC.

Kyle A. Richards

Ashok K. Hemal

Robotic Radical Cystectomy: Where are We Today, Where will We be Tomorrow?

Bladder cancer is a major cause of morbidity and mortality. At initial diagnosis, 75% of patients present with nonmuscle-invasive disease and 25% of patients have muscle-invasive or metastatic disease.Patients with noninvasive disease suffer from a high rate of recurrence and 10–30% will have disease progression. Patients with muscle-invasive disease are primarily treated with radical cystectomy, but frequently succumb to their disease despite improvements in surgical technique. In non–muscle-invasive disease, multiplicity, tumor size, and prior recurrence rates are the most important predictors for recurrence, while tumor grade, stage, and carcinoma in situ are the most important predictors for progression. The most common tool that clinicians use to predict outcomes after radical cystectomy is still the tumor-node-metastasis (TNM) staging system, with lymph node involvement representing the most important prognostic factor. However, the predictive accuracy of staging and grading systems are limited, and nomograms incorporating clinical and pathologic factors can improve prediction of bladder cancer outcomes. One limitation of current staging is the fact that tumors of a similar stage and grade can have significantly different biology. The integration of molecular markers, especially in a panel approach, has the potential to further improve the accuracy of predictive models and may also identify targets for therapeutic intervention or patients who will respond to systemic therapies.

Ramy F. Youssef

Yair Lotan

Predictors of Outcome of Non–Muscle-Invasive and Muscle-Invasive Bladder Cancer

Patients with high-grade Ta, T1, or carcinoma in situ non&#8211;muscle-invasive bladder cancer (NMIBC) are at high risk for recurrence and, more importantly, progression. Thus, both the American Urological Association and European Association of Urology recommend initial intravesical treatment with bacillus Calmette-Guerin(BCG) followed by maintenance therapy for a minimum of 1 year. The complete response rate to BCG therapy in patients with high-risk NMIBC can be as high as &#8764;80&#37;; however, most patients with high-risk disease suffer from recurrence. BCG failure can be further characterized into BCG refractory, BCG resistant, BCG relapsing, and BCG intolerant. Current recommendations include one further course of BCG or cystectomy. In patients who continue to fail conservative treatment and who refuse surgical therapy or are not surgical candidates, treatment options become even more complicated. In this setting, treatment options are limited and include repeat BCG treatment, an alternate immunotherapy regimen, chemotherapy, or device-assisted therapy. To date, however, further research is necessary for all secondary treatment options in order to determine which might be the most efficacious. All conservative treatments should be considered investigational. Currently, cystectomy remains the standard of care for high-risk patients who have failed BCG therapy.

Andrew J. Lightfoot

Henry M. Rosevear

Michael A. O&#39;Donnell

Recognition and Treatment of BCG Failure in Bladder Cancer

Restaging, or second transurethral resection (TUR), is essential to successful management of high-risk, non&#8211;muscle-invasive bladder cancer. Here we review the relevant literature documenting the role of restaging TUR. Cohort and randomized studies show that restaging TUR detects more tumors than initial TUR, improves clinical staging, and reduces the frequency of early tumor recurrences. Our conclusions show thatrestaging TUR improves the outcomes of high-risk, non&#8211;muscle-invasive bladder neoplasms.

Harry W. Herr

Role of Re-Resection in Non&#8211;Muscle-Invasive Bladder Cancer

Bladder cancer is the fifth most common cancer in Western society, with the global burden predicted to increase significantly in the foreseeable future. Over 90&#37; of these bladder cancers are transitional cell carcinomas of urothelial origin (urothelial carcinomas or UCs) and at presentation, over 70&#37; will be non&#8211;muscle-invasive or stage Ta/T1 tumours, with the remainder being muscle-invasive or stages T2-4. Bladder UC is a highly heterogeneous disease: for the 50&#8211;55&#37; of bladder cancer patients presenting with Ta tumours, recurrence is the main issue, but for the 20&#8211;25&#37; of patients presenting with T1 tumours, progression is the main issue. Progression to, or presentation with, muscle-invasive disease represents the critical step for patients, necessitating more aggressive therapies and carrying significantly worse survival rates. We therefore urgently require detailed molecular insights into the pathogenesis of muscle-invasive bladder cancer so that the disease can be more adequately and appropriately treated at presentation, so that progression from stages Ta/T1 can be abrogated, and so that the risk of recurrence following treatment can be minimised. The recently identified bladder cancer stem cells are considered to be mediators of resistance to current therapies and therefore represent strong candidate biological targets. The aim of this review is to discuss the background and basic science of such cells, and the implications for current and future therapies.

Bladder Cancer and Cancer Stem Cells: Basic Science and Implications for Therapy

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The Scientific World Journal | Hindawi

The Scientific World Journal

This Issue is now open for submissions.
Papers are published upon acceptance, regardless of the Special Issue publication date.

The Scientific World Journal

Bladder Cancer

Bladder Cancer

Articles

Emerging Endoscopic and Photodynamic Techniques for Bladder Cancer Detection and Surveillance

Bladder Cancer

Update on Chemotherapy in the Treatment of Urothelial Carcinoma

Current and Emerging Bladder Cancer Urinary Biomarkers

Robotic Radical Cystectomy: Where are We Today, Where will We be Tomorrow?

Predictors of Outcome of Non–Muscle-Invasive and Muscle-Invasive Bladder Cancer

Recognition and Treatment of BCG Failure in Bladder Cancer

Role of Re-Resection in Non–Muscle-Invasive Bladder Cancer

Bladder Cancer and Cancer Stem Cells: Basic Science and Implications for Therapy