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Review
. 2025 Mar;27(3):236-246.
doi: 10.1007/s11912-025-01645-7. Epub 2025 Feb 20.

Advancements in the Diagnosis, Treatment, and Risk Stratification of Non-Muscle Invasive Bladder Cancer

Shayan Smani  1 , Julien DuBois  1 , Kai Zhao  1 , Ryan Sutherland  1 , Syed N Rahman  1 , Peter Humphrey  2 , David Hesse  1 , Wei Shen Tan  1 , Darryl Martin  1 , Soum D Lokeshwar  1 , Fady Ghali  3
Affiliations
Review

Advancements in the Diagnosis, Treatment, and Risk Stratification of Non-Muscle Invasive Bladder Cancer

Shayan Smani et al. Curr Oncol Rep. 2025 Mar.

Abstract

Purpose of review: This review examines the evolving landscape of non-muscle invasive bladder cancer (NMIBC) management, focusing on risk stratification, novel therapeutic strategies, and the integration of biomarkers into clinical care.

Recent findings: Emerging genomic markers such as FGFR3 and TERT promoter mutations show promise for diagnosis and personalized treatment. Advances in immunotherapy, including the use of pembrolizumab and nadofaragene firadenovec, offer options for BCG-unresponsive NMIBC, though challenges like cost and adverse effects remain. Current guidelines emphasize stratified care based on risk, balancing treatment intensity with recurrence and progression risks. While transurethral resection with intravesical therapy remains the standard for most NMIBC, early radical cystectomy is pivotal for select high-risk cases. Future directions highlight the need for biomarker-driven models to refine treatment paradigms, reduce overtreatment, and improve long-term outcomes. Continued clinical trials are essential to validate these approaches and address unmet needs in NMIBC care.

Keywords: Bladder neoplasms; Immunotherapy; Non-muscle invasive bladder cancer; Radical cystectomy; Risk stratification.

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Conflict of interest statement

Declarations. Human and Animal Rights: All reported studies with human subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki declaration and its amendments, institutional/national research committee. Competing Interests: The authors declare no competing interests.

References

    1. Institute NC. SEER cancer stat facts: bladder cancer. National Cancer Institute Bethesda, MD; 2019.
    1. Mossanen M, Gore JL. The burden of bladder cancer care: direct and indirect costs. Curr Opin Urol. 2014;24(5):487–91. - PubMed
    1. Sievert KD, Amend B, Nagele U, Schilling D, Bedke J, Horstmann M, et al. Economic aspects of bladder cancer: what are the benefits and costs? World J Urol. 2009;27:295–300. - PubMed - PMC
    1. Holzbeierlein JM, Bixler BR, Buckley DI, Chang SS, Holmes R, James AC et al. Diagnosis and treatment of non-muscle invasive bladder cancer: AUA/SUO guideline: 2024 amendment. J Urol. 2024:101097.
    1. Burger M, Catto JW, Dalbagni G, Grossman HB, Herr H, Karakiewicz P, et al. Epidemiology and risk factors of urothelial bladder cancer. Eur Urol. 2013;63(2):234–41. - PubMed

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