In our experience in our admittedly small series of patients, we observed that invasive features are possible in those large bladder TCC, but not as widely encountered as perhaps expected. This means that immediate radical cystectomy might be an overtreatment in many of these tumors. On the other hand, these large bladder masses are hardly resectable transurethrally.
Therefore, similarly to other tumors, we considered applying neoadjuvant chemo-resection to reduce the tumor size before surgical treatment.
Our intention was to use the cytoreductive effect of mitomycin to resect all those bulky tumors completely in a single session. The short intensive schedule of intravesical instillations of mitomycin significantly reduced the tumor size before endoscopic resection. It allowed us to stage accurately and to spare most of the bladders, without delaying a possible radical cystectomy significantly where needed.
Even if radical cystectomy is a suitable and oncologically safe treatment for high-risk non-muscle-invasive bladder cancer, in high-risk patients with significant co-morbidities, and those refusing cystectomy, one can consider this bladder sparing strategy.
Written by: Marco Raber, MD1,2 Noor Buchholz, MD1,3
- U-merge (Urology in Emerging Countries), London, United Kingdom
- Mediclinic Middle East, Dubai, United Arab Emirates
- Department of Urology and Men’s Health, Al Garhoud Private Hospital, Dubai, United Arab Emirates