title: Indication and timing of cystectomy in high-risk bladder cancer.
abstract: OBJECTIVE
  Although the conservative approach including Bacillus Calmette-Guerin (BCG) therapy is considered as the first-line option in high-risk nonmuscle invasive bladder tumors, cystectomy is often required as an alternative treatment in the case of BCG failure. Considering all the parameters, including clinical data, endoscopic aspects and new biological markers, the question of the indication, and moreover timing, of cystectomy has become crucial.
  
  
  RESULTS
  In fact, the real positive effect of BCG remains controversial and its actual benefit in terms of survival is not evident. Therefore, early cystectomy for this population with high risk of progression and metastasis diffusion is clearly a radical approach which can lead to a reduction in specific mortality. Recent articles have studied the parameters involved in this issue to determine the exact timing of cystectomy.
  
  
  CONCLUSIONS
  To avoid delay of appropriate treatment, it is crucial to determine the non-BCG responder population. Unfortunately, no consensual marker is currently available. Nevertheless, multifocal tumors, associated carcinoma in situ, prostatic urethral involvement, tumoral size greater than 3 cm and depth of infiltration are useful parameters in clinical practice to propose early cystectomy. In the future, the crucial question of cystectomy timing may be answered by progress in molecular signatures for bladder cancers.
authors: Department of Urology, Hôpital Foch, Suresnes, Paris, France. T.lebret@hopital-foch.org
authors: Thierry
authors: T
authors: Lebret
authors: Yann
authors: Y
authors: Neuzillet
mesh_terms: D001500:BCG Vaccine / Q000627:therapeutic use; D015653:Cystectomy; D018450:Disease Progression; D006801:Humans; D012307:Risk Factors; D013997:Time Factors; D017211:Treatment Failure; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery*
chemical_list: D001500:BCG Vaccine