Future strategies in the diagnosis, staging and treatment of bladder cancer.
OBJECTIVE
In this review new modalities in the diagnosis, staging and treatment of superficial and invasive bladder cancer are reviewed.


RESULTS
Urinary markers still cannot replace cystoscopy in diagnosing bladder cancer. However, DNA micro-array has shown promise for diagnosis. In the treatment of superficial bladder cancer, valrubicin, pirarubicin and gemcitabine are novelties. Furthermore, a combination therapy of hyperthermia and mitomycin-C as well as photodynamic therapy seem to be safe and effective new treatment modalities. For staging, computed tomography, magnetic resonance imaging and the positron emission tomography scan are limited. Nevertheless, the pT-category, pN-category and the number of lymph nodes removed affect survival significantly and are thus useful for staging and prognosis. This indicates a need for a standardized lymph node dissection in cystectomy patients.


CONCLUSIONS
In the treatment of invasive bladder cancer, prostate-sparing cystectomy shows promising potency and continence results. In advanced disease, gemcitabine-cisplatin is a valuable alternative to methotrexate-vinblastine-doxorubicin-cisplatin with fewer side-effects. Finally, radical radiotherapy should be considered a valid treatment in patients with invasive bladder cancer.
van der Heijden
Antoine G
AG
Department of Urology, Medical Centre, St Radboud, Nijmegem, the Netherlands.
Witjes
J Alfred
JA
D003950:Diagnostic Techniques, Urological / Q000639:trends; D006801:Humans; D009367:Neoplasm Staging / Q000639:trends; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy*