In high-grade non-muscle invasive bladder cancer, tumor removal followed by immunotherapy appears to reduce deaths directly caused by cancer, but surgery to remove the bladder entirely offers a midterm survival advantage. These findings published recently in the Annals of Medicine and Surgery highlight the need for individualized treatment decisions in bladder cancer.
In this meta analysis of five studies including 4,867 patients, researchers compared a bladder preservation approach with radical cystectomy, the removal of the bladder. Most patients had T1G3 high-risk disease, and the average age was older than 67 years.
Most patients who received treatment that preserved their bladder had transurethral resection of bladder tumor (TURBT, a procedure that removes tumors from inside the bladder) followed by intravesical Bacillus Calmette Guérin (BCG) immunotherapy. Follow-up ranged from 46 to 99.6 months.
Survival rates depended on how far out patients were followed. At two years, people lived about the same amount of time whether they had bladder preservation or bladder removal. At five years, those who had their bladder removed tended to live longer. However, by 10 years, survival was again similar between the two groups. Overall, this suggests that while surgery may offer a midterm advantage, the shorter and longer term outcomes are fairly comparable.
When focusing only on deaths caused by bladder cancer, bladder preservation showed a clear benefit. Fewer patients died from their cancer at both two years and five years when their bladder was preserved rather than removed. In simple terms, keeping the bladder was linked to a lower chance of dying from bladder cancer during those earlier time periods.
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“Despite this, determining the optimal [bladder preservation approach] method remains a challenge,” the study’s authors noted.
For patients, these results reinforce that there is no one-size-fits-all answer. Bladder preservation may be the best choice for older adults and those with T1G3 tumors because it can avoid major surgery and maintain quality of life while still controlling cancer. On the other hand, younger patients or those seeking a more aggressive approach may still consider bladder removal, particularly given its five-year survival advantage.
Experts emphasized that treatment decisions should balance cancer control with quality of life, risks of recurrence and personal preferences. Because the available studies were limited and varied, more high-quality research is needed to clarify which patients benefit most from each strategy and to improve bladder preserving therapies further.
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