Bladder cancer

Chapter 8b discusses the considerable controversy as to the optimal management of localized, muscle invasive bladder cancer. Surgical removal of the bladder is considered the ‘gold standard’ in many countries but there is no randomized trial to underpin this statement, and many patients are unfit for surgery. Reported 5-year survival rates with radiotherapy are remarkably similar to surgical series. Thus even if surgery is genuinely better than radiotherapy for patients fit for both approaches, there are many patients for whom radical surgery is simply not suitable and hence bladder-preserving techniques are appropriate.