What Are The Risks Of Bladder-Sparing Therapy?
Bladder-sparing protocols have largely shown similar rates of long-term survival compared with immediate cystectomy. The studies have been criticized, however, as falsely improving their results by selecting only those patients who were already likely to do well.
This could mean that there is in fact a survival advantage to having immediate surgery rather than waiting until after a trial of chemotherapy.
Patients who show evidence of tumor recurrence on these treatments will usually then undergo a radical cystectomy with urinary diversion. There have been concerns raised by some experts that the delay in time to radical cystectomy while having chemotherapy may increase the risk of metastases significantly, but definitive data on this do not exist.
Another disadvantage to these treatments is that they are very complex and require close cooperation between several specialists and a commitment on the part of the patient. This means that they can be offered only at a few specialized centers and only to a few patients.
Even in those patients who successfully salvage their bladder with these treatments, some will have decreased bladder capacity or suffer from severe urgency after treatments. With the advent of new techniques to create a neobladder, most patients who could complete the bladder-sparing protocol would do as well or better with immediate surgery and neobladder.