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World Journal of Urology
Published in: World Journal of Urology 6/2012

01-12-2012 | Invited Review

High-risk non-muscle-invasive bladder cancer: update for a better identification and treatment

Authors: Oscar Rodriguez Faba, Joan Palou, Alberto Breda, H. Villavicencio

Published in: World Journal of Urology | Issue 6/2012

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Abstract

Purpose

Despite standard treatment with transurethral resection (TUR) and adjuvant bacillus Calmette–Guérin (BCG), many high-risk bladder cancers (HRBCs) 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 HRBC.

Methods

A MEDLINE® search was conducted to identify the published literature relating to early identification and treatment for non-muscle-invasive bladder cancer. Particular attention was paid to factors such as quality of TUR, importance of second TUR, substaging, and CIS. In addition, studies on urinary markers, photodynamic diagnosis, predictive clinical and molecular factors for recurrence and progression after BCG, and best management practice were analysed.

Results and conclusions

Good quality of TUR and the implementation of photodynamic diagnosis in selected cases provide a more accurate diagnosis and reduce the risk of residual tumour in HRBC. Although insufficient evidence is available to warrant the use of new urinary molecular markers in isolation, their use in conjunction with cytology and cystoscopy may improve early diagnosis and follow-up. BCG plus maintenance for at least 1 year remains the standard adjuvant treatment for HRBC. Moreover, there is enough evidence to consider the implementation of new specific risk tables for patients treated with BCG. In HRBC patients with poor prognostic factors after TUR, early cystectomy should be considered.
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Metadata
Title
High-risk non-muscle-invasive bladder cancer: update for a better identification and treatment
Authors
Oscar Rodriguez Faba
Joan Palou
Alberto Breda
H. Villavicencio
Publication date
01-12-2012
Publisher
Springer-Verlag
Published in
World Journal of Urology / Issue 6/2012
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI
https://doi.org/10.1007/s00345-012-0967-1

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