Bladder cancer: Management and future directions

Bladder cancer accounts for approximately 5-10% of all cancers in the United States and Europe and is the fourth most common malignancy among men. The incidence of bladder cancer increases with age and risk can be exacerbated by smoking, exposure to industrial carcinogens, and infection with schistosomiasis. Optimal patient management requires an accurate knowledge of the stage and grade of the disease, and an appraisal of the risk of progression and recurrence is required to plan the best course of treatment. At every diagnostic and therapeutic step there exist opportunities to optimise outcomes. Recent advances in the management of bladder cancer include the use of fluoroscopic and cystoscopic detection, intravesical therapy, neoadjuvant chemotherapy, and bladder-sparing multimodal therapy. Moreover, new understanding of molecular markers may provide more accurate prognosis in the future and enable treatment to be tailored to individual patients. The urologic community should strive to consider and implement new approaches in the longitudinal care of patients with bladder cancer. (c) 2006 European Association of Urology. Published by Elsevier B.V. All rights reserved