Approximately 75% to 80% of cases are nonmuscle-invasive bladder cancer (NMIBC), an often chronic condition with high recurrence rates necessitating lifelong surveillance and repeated interventions. Despite contemporary favorable 5-year cancer-specific survival ranging from 71% to 96%, patients experience substantial physical, psychological, and financial burdens due to the significant and invasive follow-up monitoring and treatment of recurrences. TURBT and adjuvant intravesical therapy remain the cornerstone of treatment of NMIBC, and we discuss some innovations within this space, with novel agents and new techniques. Further, we focus on symptom management for patients undergoing therapy and enhancing bladder cancer survivor's quality of life.
White-light cystoscopy (WLC) may miss small, non-papillary, flat lesions, commonly associated with high-grade lesions such as carcinoma in situ. Enhanced cystoscopy techniques, including blue-light cystoscopy (BLC), narrow-band imaging, and IMAGE1 S, aim to address the shortcomings of traditional WLC in detecting bladder cancer. These techniques enhance the detection of tumors, although whether the improved sensitivity translates into better recurrence-free and progression-free survival is less certain. BLC should be utilized in patients with suspicious cytology and unrevealing WLC.
Non-Muscle-Invasive Bladder Cancer poses significant therapeutic challenges due to high recurrence and progression rates. While intravesical Bacillus Calmette-Guérin (BCG) has long been the standard, limitations in efficacy, global shortages, and patient-specific contraindications to radical cystectomy have fueled the development of novel bladder-sparing therapies. Recent advances include UGN-102 for low-grade/intermediate-risk disease and multiple FDA-approved agents-nadofaragene firadenovec, TAR-200, and nogapendekin alfa inbakicept-for BCG-unresponsive disease. Ongoing trials of TAR-210, cretostimogene, and other combination regimens promise to further expand options. Comparative studies and real-world evidence will be critical to define optimal sequencing, benchmark outcomes against radical cystectomy, and address quality-of-life considerations.
Bladder cancer is the fourth most common cancer in males, and roughly 75% of new bladder cancer is non-muscle-invasive. Traditional surveillance protocols are costly and time-intensive for patients. Some studies report that more than half of patients with low-risk bladder cancer undergo too many surveillance procedures, and one-third of the patients with high-risk bladder cancer do not undergo enough procedures. As technology improves, surveillance protocols may deintensify the use of cystoscopy and incorporate less invasive alternatives. There is a great deal of ongoing research in noninvasive tests that may be used for surveillance in the future.
