Overall, the vast majority of patients with early bladder cancer are in remission after first resection but require careful and prolonged follow-up as there is a chance of both local recurrence and of new tumours developing.
Local relapse in the bladder after conservative therapy (i.e.chemotherapy and radiotherapy) is an indication for the doctor to recommend cystectomy with a high chance of cure.
Once the cancer is muscle invasive (pT3+) the overall chance of cure falls substantially, such that only perhaps 50% of patients will be ultimately cured. This is the main reason that so much effort towards improving results (such as the concomitant use of chemotherapy with radiotherapy) is under trial attention at present.
Where the tumour has spread to other organs, and the bones and later the liver and lungs are at particular risk, is an indication for chemotherapy; however, such chemotherapy is not curative and it use will depend on the patients condition, i.e. it may not be recommended for those in particularly poor health. Agents such as cis-platinum and gemcitabine are the best of the chemotherapy armamentarium; their use must be by specialist oncologists, not least because they are toxic, for example to the kidneys. Their supervision and audit of their usefulness needs to made critically.
