Should radical cystectomy be considered an alternative treatment to bladder preservation trimodality therapy in patients with muscle-invasive bladder cancer?—No.
Radical cystectomy should not be considered an alternative treatment to trimodal therapy. Instead, it should be considered the gold-standard treatment for patients with muscle-invasive bladder cancer (MIBC).
According to the European Association of Urology guidelines, radical cystectomy (RC) is given a grade A recommendation for treating T2-T4aN0M0 and high-risk nonmuscle-invasive bladder cancer. Radical cystectomy is given a grade A based on clinical studies of good quality and consistency and involving at least 1 randomized clinical trial. Multimodality bladder–sparing therapy, on the other hand, should only be considered an alternative option for selected pT2N0M0 tumors and is not the standard of care. The European Society of Medical Oncology guidelines similarly recommend radical cystectomy with extended lymphadenectomy as the standard of care in MIBC, as do the guidelines of the National Comprehensive Cancer Network.
Chedgy ECP, Black PC. Radical Cystectomy and the Multidisciplinary Management of Muscle-Invasive Bladder Cancer. JAMA Oncol. 2016;2(7):855-856. doi:10.1001/jamaoncol.2016.0149