The role of biomarkers in bladder preservation management of muscle-invasive bladder cancer

  • Timur MitinEmail author
  • Ananya Choudhury
Topic Paper



Patients with localized muscle-invasive bladder cancer (MIBC) can choose to undergo either neoadjuvant chemotherapy followed by radical cystectomy or radiation therapy-based bladder preservation treatment modality with subsequent close cystoscopic surveillance with salvage cystectomy reserved for patients with evidence of local disease recurrence. At the present time, the decision regarding bladder-directed local therapy for MIBC is based on physicians’ and patients’ preferences, and does not take into account tumor biology. Predictive biomarkers, once validated, could offer a more patient-centered and biology-driven selection of bladder-directed therapies.


We provide a narrative review of clinical data pertaining to the biomarkers in bladder preservation management of MIBC.


There are currently no validated and clinically used biological markers used for stratification of radical bladder treatment and selection of bladder-preserving therapies. This article summarizes biomarkers that could have a potential clinical utility—PD-L1, molecular subtypes, Ki-67, MRE-11 and markers of hypoxia—and offers a hypothetical pathway model for a marker-driven precision management of medically operable patients with a newly diagnosed MIBC.


When selecting the optimal cancer treatment, both patient and tumor factors need to be considered. Once validated, biological markers will help clinicians tailor the management of MIBC to individual patients.


Bladder cancer Muscle-invasive bladder cancer Radiation oncology Biomarkers Bladder preservation Precision oncology 


Author’s contribution

TM Project development, Manuscript writing and editing. AC Project development, Manuscript writing and editing.

Compliance with ethical standards

Conflict of interest

T Mitin and A Choudhury have no conflicts of interest to disclose.

Human and animals rights

This publication did not involve research involving human participants and/or animals and no informed consent was required.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Radiation Medicine, Knight Cancer InstituteOregon Health and Science UniversityPortlandUSA
  2. 2.Department of Clinical OncologyThe Christie NHS Foundation TrustManchesterUK
  3. 3.Division of Molecular and Clinical Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and HealthUniversity of Manchester Academic Health Science CentreManchesterUK

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