Optimal timing of radical cystectomy for patients with T1 bladder cancer

The optimal treatment of lamina propria invasive bladder cancers remains controversial. Assigning strict treatment guidelines is hampered by the heterogeneous clinical behavior of lamina propria invasive bladder cancers. Although many T1 lesions respond very well to transurethral resection and adjuvant intravesical therapy, others demonstrate a high rate of recurrence and progression. While bladder preservation is desired by most patients, experience has documented that survival is compromised in a substantial percentage of patients if T1 disease is allowed to progress. Radical cystectomy for T1 disease is associated with an excellent survival; however, the optimal timing of radical cystectomy remains one of the more difficult clinical dilemmas in the management of patients with bladder cancer. This article reviews the various features associated with an increased risk of disease progression to provide a framework for optimizing the timing of radical cystectomy.