There are no real breakthroughs yet in 2016 for the treatment of bladder cancer (BCa) although hopes are high that ongoing research studies on immunotherapy may yet lead to promising treatment options in the coming years.
“Bladder cancer remains a challenging disease. We do hope, however, that immunotherapy may lead to promising treatment options in the future,” said Prof. Marek Babjuk during his update lecture on bladder cancer.
Babjuk noted that in Europe alone there is a rising number of bladder cancer cases and healthcare costs in 2012 was recorded at around 490 billion euros, making this malignancy one of the most fatal and challenging in urology.
“Radical cystectomy plus systemic chemotherapy is recommended for locally advanced disease,” said Babjuk as he discussed the basic management principles in BCa. He, however, noted that radical cystectomy has a high failure rate or around up to 50% of cases. Complications are also high, making the procedure a risky option for many patients.
Babjuk also mentioned that systemic chemotherapy is recommended for metastatic disease but underscored that it is not very effective in most cases and is accompanied by many side-effects.
“If we need to reduce the burden of bladder cancer, we also need to focus on preventive approaches,” commented Babjuk during the Q&A forum, adding the preventive measures, such as reducing smoking, may help lower BCa incidence. Smoking is directly linked to bladder cancer as shown in recent research studies.
In a complementary lecture, Prof. Stephan Madersbacher discussed management strategies for invasive bladder tumours in elderly patients.
Among the criteria that Madersbacher listed that doctors should look into before considering cystectomy in elderly patients are tumour size and focality, bladder function, hydronephrosis, surgical risk, cerebral capacities and the wishes or expectations of the patients, among others.
“Age per se is not a contraindication for radical cystectomy in the elderly, but in the end this is an individualized decision,” said Madersbacher while adding that experience of the surgeon is crucial in the management of elderly BCa patients. He also noted that more research should be conducted in this area and that doctors must also examine alternative forms of urinary diversion.