The morbidity associated with radical cystectomy (RC) for muscle-invasive bladder cancer (MIBC) has fueled investigations into the feasibility of bladder preservation strategies after a favorable clinical response to neoadjuvant therapy (NAT). Identifying optimal candidates for bladder preservation is predicated on our ability to identify tumors with inherent cisplatin sensitivity and accurately stage patients before and after NAT. In the present review, we evaluate the accuracy and limitations of contemporary staging modalities and investigate clinical outcomes in patients with MIBC who were managed with bladder preservation after NAT. Lastly, we discuss the predictive role of cisplatin-sensitizing DNA damage response (DDR) gene alterations as a foundational component to current prospective clinical trials evaluating bladder preservation in the setting of MIBC.
Urologic oncology. 2023 Jan 24 [Epub ahead of print]
Patrick J Hensley, Roland Seiler, Harry Herr, Kent W Mouw, Gopa Iyer, Lars Dyrskjøt, Roman Nawroth, Peter Goebell, Bernd Schmitz-Drager, Tilman Todenhofer, Peter C Black, Ashish M Kamat, Stephen B Williams
Department of Urology, University of Kentucky College of Medicine, Lexington, KY., Organoid Core, Department of BioMedical Research, University of Bern, Bern, Switzerland; Department of Urology, Hospital Center Biel, Biel, Switzerland., Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY., Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA., Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY., Department of Clinical Medicine, Aarhus University, Aarhus, Denmark., Department of Urology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany., Department of Urology and Pediatric Urology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany., Medical School, University of Tuebingen, Tuebingen, Germany., Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada., Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX., Division of Urology, The University of Texas Medical Branch, Galveston, TX. Electronic address: .