TriangleHEALTH PROFESSIONAL · SOURCE READING
Muscle-Invasive Bladder Cancer
Source: Bladder Cancer Treatment (PDQ®)–Health Professional Version, National Cancer Institute.
Source updated: May 2, 2025 · Captured 2026-09-09.
Selected source text with whitespace normalised. This Triangle page is not an NCI PDQ summary.
Context: Treatment Option Overview for Bladder Cancer
Standard treatment for patients with muscle-invasive bladder cancers whose goal is cure is either neoadjuvant multiagent cisplatin–based chemotherapy followed by radical cystectomy and urinary diversion or radiation therapy with concomitant chemotherapy.[10-13] Other treatment approaches include:
Radical cystectomy followed by multiagent cisplatin–based chemotherapy.
Radiation therapy without concomitant chemotherapy.[17]
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Partial cystectomy with or without perioperative chemotherapy.[18]
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Many patients newly diagnosed with bladder cancer are candidates for participation in clinical trials.
Reconstructive techniques that fashion low-pressure storage reservoirs from the reconfigured small and large bowel eliminate the need for external drainage devices and, in many patients, allow voiding per urethra. These techniques are designed to improve the quality of life for patients who require cystectomy.[19]
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| Stage (TNM Staging Criteria) | Treatment Options | |
|---|---|---|
| BCG = bacillus Calmette-Guérin; EBRT = external-beam radiation therapy; TNM = T, size of tumor and any spread of cancer into nearby tissue; N, spread of cancer to nearby lymph nodes; M, metastasis or spread of cancer to other parts of body; TUR = transurethral resection. | ||
| Stage 0 Bladder Cancer | TUR with fulguration followed by an immediate postoperative instillation of intravesical chemotherapy | |
| TUR with fulguration | ||
| TUR with fulguration followed by an immediate postoperative instillation of intravesical chemotherapy followed by periodic intravesical instillations of BCG | ||
| TUR with fulguration followed by an immediate postoperative instillation of intravesical chemotherapy followed by intravesical chemotherapy | ||
| Segmental cystectomy (rarely indicated) | ||
| Radical cystectomy (in rare, highly selected patients with extensive or refractory superficial high-grade tumors) | ||
| Stage I Bladder Cancer | TUR with fulguration followed by an immediate postoperative instillation of intravesical chemotherapy | |
| TUR with fulguration | ||
| TUR with fulguration followed by an immediate postoperative instillation of intravesical chemotherapy followed by periodic intravesical instillations of BCG | ||
| TUR with fulguration followed by an immediate postoperative instillation of intravesical chemotherapy followed by intravesical chemotherapy | ||
| Segmental cystectomy (rarely indicated) | ||
| Radical cystectomy in selected patients with extensive or refractory superficial tumors | ||
| Stages II and III Bladder Cancer | Radical cystectomy | |
| Neoadjuvant chemoimmunotherapy followed by radical cystectomy followed by adjuvant immunotherapy | ||
| Neoadjuvant combination chemotherapy followed by radical cystectomy | ||
| Radical cystectomy followed by adjuvant chemotherapy or immunotherapy | ||
| EBRT with or without concomitant chemotherapy | ||
| Segmental cystectomy (in selected patients) | ||
| TUR with fulguration (in selected patients) | ||
| Stage IV Bladder Cancer | T4b, N0, M0 | Enfortumab vedotin plus pembrolizumab |
| Chemotherapy plus immunotherapy | ||
| Chemotherapy alone | ||
| Systemic therapy followed by radical cystectomy | ||
| EBRT with or without concomitant chemotherapy | ||
| Urinary diversion or cystectomy for palliation | ||
| Any T, any N, M1 | Enfortumab vedotin plus pembrolizumab | |
| Chemotherapy plus immunotherapy | ||
| Chemotherapy alone or as an adjunct to local treatment | ||
| Immunotherapy | ||
| EBRT for palliation | ||
| Urinary diversion or cystectomy for palliation | ||
| Other chemotherapy agents with activity in metastatic bladder cancer, such as paclitaxel, docetaxel, ifosfamide, gallium nitrate, and pemetrexed (under clinical evaluation) | ||
| Clinical trials | ||
| Recurrent Bladder Cancer | Combination chemotherapy | |
| Immunotherapy | ||
| Targeted therapy | ||
| Surgery for new superficial or localized tumors | ||
| Palliative therapy | ||
| Clinical trials | ||
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- TNM Staging Criteria
- TUR with fulguration followed by an immediate postoperative instillation of intravesical chemotherapy
- TUR with fulguration followed by an immediate postoperative instillation of intravesical chemotherapy followed by periodic intravesical instillations of BCG
- Segmental cystectomy
- Radical cystectomy
- TUR with fulguration followed by an immediate postoperative instillation of intravesical chemotherapy
- TUR with fulguration
- TUR with fulguration followed by an immediate postoperative instillation of intravesical chemotherapy followed by periodic intravesical instillations of BCG
- TUR with fulguration followed by an immediate postoperative instillation of intravesical chemotherapy followed by intravesical chemotherapy
- Segmental cystectomy
- Radical cystectomy
- Radical cystectomy
- Neoadjuvant chemoimmunotherapy followed by radical cystectomy followed by adjuvant immunotherapy
- Neoadjuvant combination chemotherapy followed by radical cystectomy
- Radical cystectomy followed by adjuvant chemotherapy or immunotherapy
- EBRT with or without concomitant chemotherapy
- Segmental cystectomy
- TUR with fulguration
- Enfortumab vedotin plus pembrolizumab
- Chemotherapy plus immunotherapy
- Chemotherapy alone
- EBRT with or without concomitant chemotherapy
- Urinary diversion or cystectomy
- Enfortumab vedotin plus pembrolizumab
- Chemotherapy plus immunotherapy
- Chemotherapy alone or as an adjunct to local treatment
- Immunotherapy
- EBRT
- Urinary diversion or cystectomy
- Combination chemotherapy
- Immunotherapy
- Targeted therapy
- Surgery
- Palliative therapy
- Clinical trials
Publication references
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