Nonmuscle-invasive bladder cancer (NMIBC) is a challenging disease to manage
primarily due to its varied clinical course. The management of NMIBC has
witnessed a widespread change with respect to its diagnosis and treatment.
Although transurethral resection (TUR) and adjuvant bacillus Calmette–Guerin
(BCG) stills remain the cornerstone, newer protocols has come into vogue to
achieve optimal care. On the basis of a literature review, we aimed to
establish ‘what changes has already occurred and what is expected in the
future’ in NMIBC.
Methods
A Medline search was performed to identify the published literature with
respect to diagnosis, treatment and future perspectives on NMIBC. Particular
emphasis was directed to determinants such as the quality of TUR and the
newer modifications, Re-TUR, current status of newer macroscopic and
microscopic imaging, role of urinary biomarkers, clinical, histologic and
molecular predictors of high-risk disease, administration of intravesical
agents, salvage therapy in BCG recurrence and the current best practice
guidelines were analyzed.
Results and Conclusions
Optimal TUR, restaging in select group, incorporation of newer endoscopic
imaging and judicious administration of intravesical chemo-immunotherapeutic
agents can contribute to better patient care. Although there is a plethora
of urinary markers, there is insufficient evidence for their use in
isolation. The future probably lies in identification of genetic markers to
determine disease recurrence, nonresponders to standard treatment and early
institution of alternative/targeted therapy.
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