Roman Tomaškin, Boris Eliáš, Ján Kliment
The fruitfulness of Ta-T1 bladder tumours (NMIBC) therapy depends on a meticulous transurethral resection of all papillary lesions (TURBT), a selection of appropriate adjuvant intravesical therapy and a proper follow-up of patients with such disease. High frequency of recurrence indicates an insufficient and improper therapy of NMIBC with underestimated risk for the patient. Even a superior TURBT cannot prevent a development of recurrence (with frequency 50-70 %) or progression (with up to 30 % rate) depending on clinical and histopathological characteristics of papillary tumours (pathological stage, grade, number and size of tumours, if it is primary or recurrent tumour etc.). Further, intravesical therapy is therefore the essential tool to reduce the risk of recurrence or progression. An immediate single instillation of chemotherapeutic agent within 6 hours after surgery is indicated as a definitive treatment for patients with low risk of recurrence and progression. A single instillation is suboptimal in case of intermediate or high risk of recurrence, therefore adjuvant therapy should continue. Intravesical immunotherapy is probably more effective than chemotherapy; however, its superiority was proven only with maintenance therapy lasting at least 1 year. But this therapy is in real clinical practice often terminated just after induction course (adverse events, non-compliance of patient, urologist decision), patients remain untreated with resulting treatment failure (recurrence or progression of disease). Intravesical chemotherapy is definitely an equal treatment option to immunotherapy in case of an intermediate risk of recurrence and a low risk of progression. If we can assume that the patient with high risk of recurrence will not complete at least 1-year intravesical therapy according to recommended schedule, we should rather prefer intravesical chemotherapy than a suboptimal course of immunotherapy or even no treatment, which unfortunately is not a rare case. Remember, bladder cancer in Ta-T1 stage is still oncological, potentially lethal condition and prognosis of inadequately managed patients is serious.