Bladder Preservation Therapy

An innovative treatment approach that combines surgical tumor removal with chemotherapy and radiation therapy, bladder preservation therapy may be an option for a patient with a certain type and stage of bladder cancer. The goal is to eliminate the tumor while preserving bladder and urinary function, providing the patient with the best possible outcome and quality of life. 

When is bladder preservation therapy used for bladder cancer?

Bladder preservation therapy is not suitable for every patient. However, it can be an effective treatment strategy for those who meet specific medical and clinical criteria. In general, the patient will be evaluated based on the type, stage and location of the tumor, as well as their overall health and personal preferences.

With an ever-deepening understanding of bladder cancer and more and more effective treatment options, we will soon be able to offer patients dynamic, personalized treatment courses to help keep their bladders, while keeping the disease at bay.

Roger Li, MD

An ideal candidate for bladder preservation therapy will meet the following criteria:

• Localized tumor – A solitary, muscle-invasive tumor is confined to the bladder.
• No evidence of lymph node involvement or distant metastasis – Imaging studies confirm that the cancer has not spread to nearby lymph nodes or distant organs.
• Complete tumor removal via TURBT – A critical first step in the bladder-sparing treatment approach, transurethral resection of bladder tumor (TURBT) must allow for complete removal of all visible cancer.
• Adequate bladder function – The patient must have a well-functioning bladder with sufficient capacity and the ability to empty it effectively.
• Willingness to undergo chemoradiation and follow-up – The patient must be physically able and willing to receive chemotherapy and radiation therapy, which are essential components of the bladder preservation protocol. The patient must also commit to receiving frequent follow-up care, including periodic cystoscopies and imaging tests to monitor for cancer recurrence.
• Preference to avoid radical surgery – Some patients might prefer a bladder-sparing treatment approach due to concerns about the lifestyle changes that may follow bladder removal, such as living with a urinary diversion.

To confirm that the treatment plan is appropriate and aligned with the patient’s goals and health status, bladder preservation therapy should always be discussed in a multidisciplinary setting, with input from urologists, oncologists and radiation specialists.

What are the potential benefits of bladder preservation therapy?

Traditionally, complete bladder removal (radical cystectomy) was the primary treatment for advanced or high-risk bladder cancer. This major surgery involves removing the entire bladder and several surrounding structures, including the prostate and seminal vesicles in men and the uterus, ovaries, fallopian tubes and a portion of the vaginal wall in women. Because the bladder is completely removed, the surgeon must also perform a urinary diversion procedure to create a new way for the body to store and pass urine.

For certain patients with muscle-invasive bladder cancer, bladder preservation therapy offers a less invasive alternative to bladder removal, potentially providing effective cancer control with fewer lifestyle disruptions and physical complications. Compared to radical cystectomy, key advantages of bladder preservation therapy include:

Bladder preservation

One of the primary benefits of bladder preservation therapy is the ability to maintain the patient’s natural bladder. This will allow for continued urinary function through the urethra, helping the patient avoid the need for a urinary diversion or urostomy. Preserving the bladder also supports better quality of life by maintaining more normal urinary patterns and reducing the psychological impact of losing a major bodily organ.

Comparable cancer control

In properly selected cases, including those involving early-stage or localized muscle-invasive bladder cancer, bladder preservation therapy has demonstrated oncologic outcomes similar to those of radical cystectomy. With close monitoring and adherence to treatment protocols, some patients can achieve effective tumor control without complete bladder removal.

Reduced surgical risks

Because bladder preservation therapy avoids the need for major abdominal surgery, the patient is at lower risk of intraoperative and postoperative complications. This includes a reduced likelihood of significant blood loss, infection and a prolonged hospital stay. The recovery time is typically shorter, and many patients are able to resume their daily routine more quickly than those who undergo radical cystectomy.

What does bladder preservation therapy involve?

Bladder preservation therapy is a multi-step, multimodal approach designed to treat bladder cancer while maintaining the structure and function of the organ. The treatment combines surgery, chemotherapy and radiation therapy to effectively target cancer cells while minimizing the need for complete bladder removal.

Key components of bladder preservation therapy include:

Transurethral resection of bladder tumor

The first step of bladder preservation therapy is TURBT, a minimally invasive procedure that involves removing all visible cancer cells from the bladder. After inserting a thin surgical tool (cystoscope) into the urethra and guiding it into the bladder, the surgeon can examine the surface of the bladder wall, use a small wire loop to remove suspicious tissues and apply a high-frequency electrical current to destroy any remaining abnormal cells. TURBT is critical for debulking the tumor.

Concurrent chemoradiation therapy

After TURBT, the patient will receive a combination of chemotherapy and radiation therapy. Radiation therapy will be directed to the bladder to destroy any remaining cancer cells, and chemotherapy will be administered simultaneously to enhance the effects of the radiation and treat any microscopic cancer cells that may be present outside the immediate treatment area.

Close monitoring and follow-up

Regular follow-up care will be essential to monitor the bladder for cancer progression or recurrence. Typically, this will involve periodic cystoscopies, urinalyses and imaging studies. If the cancer does not respond to bladder preservation therapy or returns, a radical cystectomy may still be necessary.

How to prepare for bladder preservation therapy

Preparing for bladder preservation therapy involves a combination of medical evaluations, lifestyle adjustments and planning for a multi-step treatment process. Because this intensive approach includes surgery, chemotherapy and radiation therapy, the patient should be in good overall health and ready to actively participate in their care.

Medical evaluation and testing

Diagnostic imaging, such as computed tomography (CT), magnetic resonance imaging (MRI) or positron emission tomography (PET) scans, will be performed to confirm that the cancer is confined to the bladder and has not spread to other organs or tissues. A complete transurethral resection of the bladder tumor will be performed to assess the tumor depth and margins and remove all visible cancer cells. A urinalysis, blood work and a full review of the patient’s medical history will be needed to evaluate their overall health and determine their ability to tolerate chemotherapy and radiation treatment. The patient may also undergo urodynamic studies to assess their bladder function and capacity.

Consultations with specialists

A multidisciplinary team, including a urologist, medical oncologist and radiation oncologist, will work together to confirm the patient’s candidacy for bladder preservation therapy. The patient will then receive detailed information about the treatment sequence, benefits, risks and expectations. The healthcare team will review the patient’s current medications, particularly blood thinners and immune-suppressing drugs, which may need to be adjusted temporarily.

Lifestyle and practical preparations

The patient should stop smoking, if applicable, because tobacco use can reduce treatment effectiveness and increase the risk of complications. A nutritional assessment may be recommended to help the patient maintain strength during bladder preservation therapy. Transportation and support should be arranged for medical appointments, particularly during chemotherapy and radiation treatment, which will require regular visits over several weeks. Mental and emotional readiness are also important.

Because bladder preservation therapy requires strict adherence to follow-up care and ongoing surveillance, the patient should feel confident in their ability to commit to long-term monitoring. Psychological support or counseling may be helpful to address concerns about treatment and quality of life. Taking time to thoroughly prepare for bladder preservation therapy can help reduce the risk of complications, ensure a smoother treatment experience and support the best possible outcome.

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What to expect after bladder preservation therapy

Following bladder preservation therapy, the patient can expect a period of recovery, ongoing monitoring and possible side effects related to the treatment components. Since this multimodal approach combines surgery, chemotherapy and radiation therapy, recovery can vary depending on how the patient tolerates each phase of treatment. The goal is to control the cancer while preserving the patient’s bladder function and quality of life.

Recovery and possible side effects

Some urinary changes are common after bladder preservation therapy, such as increased urgency, increased frequency and mild discomfort during urination. These symptoms often improve with time, but may persist in some cases. Fatigue is a frequent side effect of chemoradiation and can last for up to several weeks. Bowel changes, such as loose stools or mild cramping, are also possible, especially after radiation therapy. Most patients resume their daily activities gradually over a few weeks to a few months.

Surveillance and follow-up care

Long-term monitoring is essential to detect any signs of cancer recurrence early. Follow-up will involve testing at scheduled intervals, including:

• Cystoscopy to examine the inside of the bladder
• Urinalysis
• Imaging studies, such as CT scans

These evaluations are typically performed more frequently during the first two years after treatment and may be scheduled at longer intervals if no recurrence is detected.

Possible additional treatment

If the cancer recurs or progresses despite bladder preservation therapy, the patient may still require a radical cystectomy. However, with a good response to treatment and consistent follow-up care, long-term bladder function and cancer control are often achievable.

What are the risks and potential complications of bladder preservation therapy?

While bladder preservation therapy can be a valuable alternative to radical cystectomy for select patients with bladder cancer, it is not without risks. This multimodal treatment combines surgery, chemotherapy, and radiation therapy, each of which can cause side effects or complications. Additionally, the long-term success of this approach depends on close follow-up and monitoring, as there is a risk of cancer recurrence.

Short-term risks and side effects of bladder preservation therapy include:

• Urinary symptoms – Radiation therapy may irritate the bladder, potentially leading to urinary discomfort, urgency and frequency as well as difficulty emptying the bladder. These symptoms typically improve over time but may persist in some cases.
• Bowel changes – Radiation treatment directed to the bladder can affect the nearby bowel, causing temporary diarrhea, cramping and rectal discomfort. Usually, these effects are mild and manageable.
• Fatigue and weakness – Fatigue is common during and after chemotherapy and radiation therapy, especially when the treatments are given concurrently. The patient’s energy levels should improve gradually after completion of therapy.
• Chemotherapy-related side effects – Chemo can cause nausea, vomiting, low blood cell counts and increased risk of infection. These side effects can vary in severity depending on the type and dosage of the drugs used.

The long-term risks and potential complications of bladder preservation therapy include:

• Bladder function changes – Some patients may experience lasting urinary changes, including reduced bladder capacity or incontinence. Long-term bladder dysfunction is uncommon but possible.
• Secondary cancer – Radiation exposure slightly increases the long-term risk of developing secondary cancer in the pelvic region, although this is rare.
• Cancer recurrence – Even in successful cases, there is a risk that the bladder cancer may return. The patient must undergo regular surveillance with cystoscopies, urinalyses and imaging tests to detect any signs of recurrence early.
• Delayed need for surgery – If the tumor does not respond adequately to bladder preservation therapy or returns, a radical cystectomy may still be required.

Benefit from world-class care at Moffitt Cancer Center

Moffitt continues to advance bladder cancer treatment and refine bladder preservation therapy by leveraging artificial intelligence (AI) and machine learning. Through extensive research studies, our scientists and clinicians are analyzing real-world data on patient-reported treatment side effects; developing predictive AI models integrating clinical, behavioral and imaging data and optimizing treatment protocols to enhance patient quality of life.

Precision in radiation delivery is a critical aspect of bladder preservation therapy due to bladder size variability and its proximity to sensitive structures. To optimize tumor targeting, Moffitt utilizes the latest radiation technologies, including MRI-guided radiation therapy and adaptive treatment planning.

If you would like to learn more about bladder preservation therapy, you are welcome to talk with a specialist in the Urologic Oncology Program at Moffitt. To request an appointment, call 1-888-663-3488 or submit a new patient registration form online. We do not require referrals.