Non-muscle-invasive bladder cancer is a common form of urological cancer that, in most cases, is initially treated with endoscopic resection followed by intravesical therapy with BCG (Bacillus Calmette-Guérin). However, approximately 30–40% of patients may develop “BCG-unresponsive” disease, meaning the cancer is no longer sensitive to this treatment.
In these situations, radical cystectomy (removal of the bladder) remains the standard treatment recommended by international guidelines, as it provides the best long-term cancer control. However , it is a complex and invasive procedure that not all patients are able or willing to undergo.
In recent years, the scientific community has therefore focused its attention on alternative strategies that allow for bladder preservation while maintaining good disease control.
A recent European multicenter study, involving 361 patients and in which our group also participated, compared various treatment options in patients with non-muscle-invasive bladder cancer that did not respond to BCG.
The following have emerged as the main alternatives to surgery:
– Gemcitabine + Docetaxel: a combination of drugs administered directly into the bladder
– Mitomycin C with EMDA technology: a method that uses an electric current to enhance the drug’s penetration into the bladder wall
The study's findings are particularly significant:
– The risk of disease progression at 2 years was lower with Gem/Doce ( 15%) and EMDA/MMC (20%) compared with additional cycles of BCG (30%)
– The 2-year cancer-specific mortality rate was 0% among study patients treated with these conservative strategies
– Il rischio di sviluppare metastasi si è mantenuto basso (<5%) in tutte le strategie di preservazione vescicale
These data suggest that, in selected and adequately informed patients, conservative treatments can be considered as an alternative to cystectomy, especially when cystectomy is not feasible or is refused.
It is important to emphasize that treatment decisions must always be tailored to the individual, taking into account the characteristics of the tumor, the patient’s clinical condition, and their preferences. Radical cystectomy remains the standard of care for eligible patients, but today we have viable options for those who wish to preserve their bladder.
