Bladder-sparing treatment in MIBC: where do we stand?

INTRODUCTION The gold-standard treatment of muscle-invasive bladder cancer is radical cystectomy (RC), but this can be associated with morbidity and perioperative risks. Patients may not be fit for RC or choose to preserve their bladders. There are evolving bladder-sparing treatments that are often delivered in a multimodal approach. Here, we aim to review recent advances in bladder-sparing treatments. EVIDENCE ACQUISITION We undertook a narrative review informed by a Medline/PubMed literature search using a combination of terms for recent (5 years) articles in English. Relevant studies from authors' bibliographies were retrieved. EVIDENCE SYNTHESIS Bladder-sparing treatment consists of transurethral resection of bladder tumour (TURBT), radiotherapy and chemotherapy. Experimental approaches with immunotherapy and using gene signatures for radiation therapy and chemotherapy response are being explored. CONCLUSIONS Bladder-sparing treatment is an option for patients with bladder cancer. Those who may benefit most are those with solitary invasive cancers, those with good bladder capacity and compliance, those who choose to preserve their bladder and sexual function and who are not fit for RC. Multimodal bladder-sparing approaches may have comparable oncological outcomes to RC and so appear an attractive alternative in suitable patients.