Radical cystectomy is the procedure of choice for many different types of patients. Most commonly, it is per-formed in patients who have muscle-invasive bladder cancer. If a bladder cancer invades the muscle, then other treatments such as TURBT and BCG are unlikely to fully treat the cancer, putting you at risk for metastases. Although invasive cancer is the most common indication for a cystectomy, it is not the only reason.
Carcinoma in situ has a high risk for progression to muscle-invasive cancer. Often, carcinoma in situ will respond to intravesical BCG or other types of intravesical treatments. Diffuse carcinoma in situ that persists despite treatment with BCG or other intravesical therapy should be treated with a radical cystectomy. This is because carcinoma in situ can become invasive and metastasize with few or no warning signs. It is also difficult or impossible to see during cystoscopy, making it difficult to monitor. These factors can lead to early cystectomy, done before the tumor becomes invasive in an attempt to prevent the cancer from spreading.
The last group of patients who may need a cystectomy is those patients whose tumors cannot be fully removed with a TURBT. There are occasionally patients whose anatomy makes it impossible to reach the entire tumor with the cystoscope. If the tumor cannot be eradicated with intravesical therapy, then they too may need a cystectomy despite only having superficial tumor.