Intravesical Therapy for Superficial Bladder Cancer

Abstract

If bladder cancer can metaphorically be thought of as weeds in the lawn, then transurethral surgery would be the equivalent of manually pulling out these weeds—an effective treatment as long as the numbers and sizes are relatively limited, the depth of the roots is relatively shallow, and the seeds of recurrence have not already been sown. A lawn rampantly overrun with weeds or one with weeds bearing very deep roots might require a more drastic solution, such as tearing up the lawn. In our metaphor, this would translate to the use of radical surgery, radiation, and/or systemic chemotherapy. Yet, as every successful lawn gardener knows, for intermediate situations the judicious local application of a weed-killer—be it chemical or more organic in origin—is superior to manual weeding alone. Analogously, this corresponds to the urologist’s use of topical intravesical chemotherapy and immunotherapy for superficial bladder cancer. Just as there is both a science and an art to effective lawn care, so there is an appropriate set of guidelines for the application of intravesical therapy that may differ depending on the specific nature of the disease.