Bladder Preservation Therapy for Muscle-Invasive Bladder Cancer

Bladder cancer is the ninth most common cancer worldwide. About two-thirds of people with bladder cancer have non-muscle invasive bladder cancer (NMIBC). The remaining third are people with muscle-invasive bladder cancer (MIBC). These two types of bladder cancer can be treated very differently.¹

When you have NMIBC, your care team will likely treat you with methods that keep your bladder intact. However, MIBC is usually treated with complete removal of the bladder (cystectomy). Bladder-removal surgeries following chemotherapy are typically the gold standard. But the drastic change in the quality of life after surgery is a growing concern.^1,2

Bladder preservation therapies (BPT)

When a person's bladder is removed, urine has to be rerouted somewhere else. This can affect a person's quality of life in many different ways. Bladder removal surgery also comes with the risk of complications and death.²

Because of this, doctors have developed new treatments called bladder preservation therapies (BPT). These therapies focus on keeping the bladder intact while treating bladder cancer. BPT aims to keep the quality of life for a person with BC as high as possible.

What is BPT?

There are two broad types of BPT: single-modality and multi-modality. Single-modality BPT uses only one kind of treatment, and multi-modality uses two or more.^1,2

Single-modality treatments are usually less effective at treating bladder cancer alone than together. But they can still be effective if your bladder cancer responds to them. Single-modality treatments include:^1,2

• Cutting out part of the tumor
• Chemotherapy
• Radiation

The most common BPT is a multi-modality therapy called trimodal therapy (TMT). People who go through TMT use all three of the single-modality methods. TMT starts with cutting out as much of the tumor as possible and then follows up with radiation and chemotherapy.^1-3

Who is a good candidate for BPT?

People with bladder cancer who respond the best to chemotherapy or radiation alone typically are the best candidates for BPT.

BPT used to be just for people with inoperable MIBC who could not undergo surgery. This was because they had other diseases at the same time or just were not up to it physically. However, now BPT is an option for people with MIBC who could undergo surgery but choose not to.²

Someone with bladder cancer who would not benefit from a sudden decrease in treatment likely will not benefit as much from BPT. Only about 10 to 15 percent of people who would otherwise get surgery are considered good candidates for it. But chemotherapy and radiation response have been shown to be good indicators of BPT response. Many times doctors use this as a gauge for whether BPT might work.²

What are the benefits and risks of BPT?

BPT and surgical bladder removal have similar survival rates. The five-year overall survival rate for people who choose BPT is 56 percent. The five-year disease-free survival rate is 45 percent. For people who choose surgical bladder removal, the overall survival rate is 60 percent and the disease-free survival rate is 53 percent.³

Keeping it functional

BPT aims to keep as much bladder function as possible. Many times, surgical removal of the bladder is what causes the quality of life issues. People who choose BPT have better general health and overall quality of life than those who undergo surgical bladder removal. They also have a better social, sexual, cognitive, and physical functions.^1,3

Weighing the risks

The main concern with BPT is the risk of MIBC coming back in the bladder after treatment. This could then require surgical bladder removal. There can be quality of life issues with BPT, but they are fewer than with bladder removal. Some people who undergo BPT can have issues that become lifelong concerns. How your body reacts to BPT dictates your quality of life after treatment.^1,2

Talk with your doctor

There are risks and benefits to every course of treatment. Talk to your doctors and care team about what path could be right for you in the short term and long term. Tell us about your experience in the comments below, or share your story with the community.