Multidisciplinary Management of Muscle-Invasive Bladder Cancer: Current Challenges and Future Directions

Bladder cancer occurred in an estimated 79,030 patients in the United States in 2017 alone, with 60,490 cases occurring in men and 18,540 in women.1 The same trends were seen in Europe, with incidence rates of 19.1 per 100,000 in men and 4 per 100,000 for women.2 Although a majority are diagnosed with superficial bladder cancers,3 up to 25% present with muscle-invasive disease, for whom the risk for progression or metastasis is substantial. Prognosis and recurrences vary by stage of disease as well as other prognostic features, including lymph node involvement, lymphovascular invasion, tumor stage, presence of variant histology, and molecular subtyping.4-6 Although RC has historically been the cornerstone of treatment for MIBC, optimizing outcomes with NAC and alternative options for bladder preservation strategies have also emerged as treatment options. In this review, we discuss the multidisciplinary management of MIBC by highlighting perioperative systemic therapy, surgical management issues, and bladder-preservation techniques and principles for MIBC. SYSTEMIC THERAPY FOR MIBC Section: ChooseTop of pageAbstractSYSTEMIC THERAPY FOR MIBC <