Metastatic Bladder Cancer

Metastatic bladder cancer is one of the leading cause of genitourinary cancer-related morality. One-third of the patients are diagnosed with organ confined disease and 10-15% are estimated to present with metastasis. Five-year survival after radical surgery alone is 62-68%. One key limitation in management may be the inability of currently available imaging modalities to reliably detect occult metastases at the time of diagnosis. Choline positron emission tomography and multiparametric magnetic resonance imaging have shown promise in improving the detection of locally advanced disease. Several biomarkers such as p53 have been investigated and, although promising for prognostication and prediction for development of metastatic disease, they are still not recommended for routine use. Neoadjuvant chemotherapy has shown to reduce the risk of bladder cancer-related death by 33%, although treatment-related toxicity has to be taken into consideration. Newer agents such as TKI and PD-L1 inhibitors have shown promising results and are currently undergoing further trials.