Predicting Prognosis in Patients with Superficial Bladder Cancer

Bladder cancer is the most common urologic malignancy and is expected to affect approximately 54,000 people in 1998. Superficial bladder tumors (Tis, Ta, and T1 lesions) account for approximately 70% to 80% of these malignancies. Although many advances have been made in the management of patients with superficial bladder cancer, such disease often recurs and can progress, leading to death. It is therefore imperative to find an accurate method of identifying patients at risk for disease progression. Many recent investigations have been conducted to determine whether new biological markers will help predict disease progression and, to a lesser extent, tumor response to treatment. These new markers include DNA ploidy, S-phase, certain monoclonal antibodies, the p53 (alias TP53) tumor-suppressor gene, the retinoblastoma (Rb) gene, cell adhesion molecules, and angiogenesis. It is hoped that such prognostic indicators, coupled with cytoscopic and pathologic characteristics of the tumor, will lead to selective aggressive treatment of patients at high risk for progression while sparing low-risk patients from unnecessary procedures.