Bladder-sparing therapy refers to any approach to the management of muscle-invasive bladder cancer in which the goal is to avoid radical cystectomy. There are a variety of approaches, mostly based on the use of chemotherapy and/or radiation combined with transurethral resection of the tumor.
In the past, chemotherapy or radiation therapy used without surgery was tried, but the results were poor. Combining chemotherapy, radiation therapy, and surgery allows some patients to avoid complete removal of their bladder. Although there has been success using this type of treatment, standard care for muscle-invasive bladder cancer remains removal of the entire bladder (radical cystectomy), with chemotherapy reserved for patients whose cancer could not be completely removed.
Of those patients embarking on bladder-sparing therapy, only 35%–40% ultimately have their bladder saved. Overall, the complete response rate to this type of treatment is about 70%. Long-term survival is about 40%–50%. In general, chemotherapy and radiation for bladder cancer is used only in those patients who either can’t or won’t have a radical cystectomy. Chemotherapy and radiation can also be used to treat recurrent bladder cancer in patients who have already had a radical cystectomy.
Patient says:
I was scheduled to have my bladder removed and was admitted for my preoperative preparation. As I started to drink the fluid that they gave me to help clean out my intestines, I became more and more anxious about the upcoming surgery. That evening I decided that I could not go through with the surgery.
I was too worried that some-thing terrible would happen to me and that my poor wife would be left alone to take care of our children. I just could-n’t do it. I told the nurses, and they called my urologist who came in to talk to me. She told me that a radical cystectomy was the best option for me, but when she realized that there was no way I was going to proceed with it, she discussed the option of chemotherapy and radiation therapy. Since it was late at night, she had me stay overnight, and the next morning I talked with the oncologist and the radiation oncologist.
The chemotherapy and radiation therapy worked for me. The urologist re-biopsied the area where my tumor was and could find no evidence of any residual cancer. I have had several CT scans that have been normal, and I have periodic cystoscopies. I am several years out and realize that I took a risk not having my bladder removed, but so far I have done well.