Weighing the Risks and Benefits of Bladder-Sparing Agents vs Cystectomy

EP: 1.Current Standards of Care and Shifting Strategies in NMIBC

EP: 2.NMIBC Treatment Decisions in the Age of BCG Shortages

EP: 3.Expert Discussion on BCG-Unresponsive NMIBC

EP: 4.Bladder-Sparing Breakthroughs: Novel FDA-Approved Treatment Options for NMIBC

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EP: 5.Weighing the Risks and Benefits of Bladder-Sparing Agents vs Cystectomy

EP: 6.What’s Next for NMIBC: The Immunotherapy and Gene Therapy Pipeline

EP: 7.Topline Data From the BOND-003 Trial in NMIBC

EP: 8.Immunotherapy in NMIBC: Key Results Safety Profile From BOND-003 Trial

EP: 9.Diving Deeper: Discussing Results From Cohort C in the BOND-003 Trial

EP: 10.Ongoing Investigations: Expanding the Role of Cretostimogene in NMIBC Care

Emerging data comparing bladder-sparing therapies to radical cystectomy in BCG-unresponsive non–muscle-invasive bladder cancer (NMIBC) is beginning to reshape perspectives on long-term outcomes. Retrospective analysis from an international cohort of over 500 patients showed no significant differences in metastasis rates, cancer-specific survival, or overall survival between those who underwent upfront cystectomy and those who pursued bladder-preserving approaches, with follow-up extending up to 50 months. However, about one-third of the bladder-sparing group eventually required cystectomy, and among them, 13% had lymph node involvement compared with just 4% in the upfront cystectomy group—highlighting possible risks associated with delayed surgery.

While retrospective and subject to selection bias, these findings underscore the complexity of treatment decisions. More nuanced data is also emerging from quality-of-life studies, notably the CISTO study presented by John Gore, MD. This prospective study evaluated patient-reported outcomes among 570 individuals and found that radical cystectomy was associated with better emotional, cognitive, and financial well-being. Interestingly, there was no significant difference between treatment groups in terms of physical function, social functioning, urinary health, or short-term survival outcomes. These results challenge assumptions that bladder preservation automatically yields better quality of life.

Taken together, these findings emphasize the importance of shared decision-making that includes both oncologic outcomes and patient-reported metrics. As more therapies become available and further data matures, especially from prospective studies like CISTO, the urologic oncology community is expected to gain deeper insights into which patients may benefit most from bladder preservation versus early surgery. The evolving evidence will help tailor care plans that align with both clinical needs and individual patient preferences.