title: Current management of non-muscle-invasive bladder cancer.
abstract: OBJECTIVE
  Despite standard treatment with transurethral resection (TURBT) and adjuvant therapy, many bladder cancers (BCs) recur and some progress. Based on a review of the literature, we aimed to establish the optimal current approach for the early diagnosis and management of non-muscle-invasive bladder cancer (NMIBC).
  
  
  METHODS
  A Medline® search was conducted to identify the published literature relating to early identification and treatment of NMIBC. Particular attention was paid to factors such as quality of TURBT, importance of second TUR, substaging, and carcinoma in situ. In addition, studies on urinary markers, photodynamic diagnosis, predictive clinical and molecular factors for recurrence and progression after BCG, and best management practice were analyzed.
  
  
  RESULTS
  Good quality of TUR and the implementation of photodynamic diagnosis in selected cases provide a more accurate diagnosis and reduce the risk of residual tumor in bladder cancer. Although insufficient evidence is available to warrant the use of new urinary molecular markers in isolation, their use in conjunction with cytology and cystoscopy can improve early diagnosis and follow-up. BCG plus maintenance for at least one year remains the standard adjuvant treatment in high-risk BC. Moreover, there is enough evidence to consider the implementation of new specific risk tables for patients treated with BCG.
  
  
  CONCLUSIONS
  In high-risk patients with poor prognostic factors after TUR, early cystectomy should be considered.
authors.affiliation: Department of Urology, Universitat Autonòma de Barcelona, Fundació Puigvert, Barcelona, Spain. orodriguez@fundacio-puigvert.es
authors.forename: O
authors.initials: O
authors.lastname: Rodriguez Faba
authors.forename: J M
authors.initials: JM
authors.lastname: Gaya
authors.forename: J M
authors.initials: JM
authors.lastname: López
authors.forename: M
authors.initials: M
authors.lastname: Capell
authors.forename: A E
authors.initials: AE
authors.lastname: De Gracia-Nieto
authors.forename: E
authors.initials: E
authors.lastname: Gómez Correa
authors.forename: A
authors.initials: A
authors.lastname: Breda
authors.forename: J
authors.initials: J
authors.lastname: Palou
mesh_terms: D000276:Adjuvants, Immunologic / Q000008:administration & dosage / Q000009:adverse effects; D001500:BCG Vaccine / Q000008:administration & dosage / Q000009:adverse effects; D002278:Carcinoma in Situ / Q000175:diagnosis / Q000628:therapy; D003131:Combined Modality Therapy / Q000379:methods; D015653:Cystectomy / Q000379:methods; D018450:Disease Progression; D042241:Early Diagnosis; D006801:Humans; D009364:Neoplasm Recurrence, Local; D012306:Risk; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis / Q000628:therapy
chemical_list: D000276:Adjuvants, Immunologic; D001500:BCG Vaccine