The Diagnosis and Treatment of Patients With Bladder Carcinoma

Abstract

Background: In Germany, bladder carcinoma accounts for 3-4 % of all malignant tumors. New study findings in the fields of endoscopy, surgery, and systemic therapy have led to multimodal treatment approaches for bladder cancer that can prolong overall survival and improve the affected patients' quality of life.

Methods: This review is based on pertinent publications retrieved by a selective search in PubMed, with special attention to the German Clinical Practice Guideline on the Early Detection, Diagnosis, Treatment, and Continuing Care of Bladder Carcinoma, along with data available on the websites of the United States Food and Drug Administration (FDA) and the European Medicines Agency (EMA). The bladder carcinoma guideline of the Onkopedia guidelines program was used as well.

Results: 75% of all urothelial carcinomas are diagnosed in the non-muscle-invasive stage. These carcinomas should be resected via the endoscopic transurethral approach whenever possible. Next, depending on the patient's risk profile, intravesical therapy may be needed. Patients with carcinoma in the muscle-invasive stage should be given multimodal treatment, including radical cystectomy with urinary diversion and perioperative systemic therapy; alternatively, bladder-preserving chemoradiotherapy can be offered in selected cases. For patients with metastatic bladder carcinoma, immunotherapy with checkpoint inhibitors has become well established for first- and second-line therapy alongside classic cytostatic treatment and has been shown to prolong patients' lives significantly. The administration of checkpoint inhibitors can prolong the overall survival of patients with metastases to 15-17 months.

Conclusion: The treatment of bladder carcinoma in all stages calls for interdisciplinary collaboration to ensure the provision of effective, individual multimodal treatment.

Figure 1

Tumor stage at initial diagnosis Distribution of UICC stages at initial diagnosis according to sex, ICD-10 C67, Germany 2015–2016 (top: including missing data and DCO cases; bottom: valid values only); UICC, Union for International Cancer Control; DCO, death certificate only

Figure 2

Sequence of first- and second-line treatment for metastatic urothelial carcinoma CTCAE, Common Terminology Criteria for Adverse Events; CPS, combined positivity score; ECOG, Performance Status of the Eastern Cooperative Oncology Group; Gem, gemcitabine; Pac, paclitaxel; PD-L1, programmed death ligand 1; IC, immune cell score; NYHA, New York Heart Association