Is radical transurethral resection for muscle invasive bladder cancer here to stay?
by Dr. Alex Shteynshlyuger MD
A number of studies have been published suggesting that transurethral resection may be an effective treatment option for some patients with focal muscle invasive bladder cancer.
While the selection criteria in these studies is fairly narrow, cancer specific survival ranges from 75-81% at 15 years which is a fairly good number in general for muscle invasive bladder cancer. The problem is that the patients treated with this approach have the lowest risk and most likely would have had significantly better survival with radical cystoprostatectomy and lymph node dissection. Some of them may have had detectable metastatic disease in lymph nodes and would have received chemotherapy immediately (at least 5% based on studies of cystoprostatectomy in patients with high-grade T1 disease).
We know that lymph node dissection for muscle-invasive bladder cancer is beneficial in terms of survival. It is also beneficial in terms of upstaging patients to additional treatment such as chemotherapy which is also life-saving.
At the present time chemotherapy for bladder cancer is not very effective. Surgery remains a better option for many patients with at least 10% absolute difference in survival.
For patients with focal muscle invasive bladder cancer who are considering radical transurethral resection as monotherapy I would strongly suggest pelvic lymph node dissection as a diagnostic, staging and therapeutic treatment option in addition to transurethral resection.