Natural history, recurrence, and progression in superficial bladder cancer

Superficial bladder cancer encompasses patients with stage Ta T1 tumors and patients with carcinoma in situ (CIS). The natural history or treatment-related prognosis of these patients varies considerably from one patient to the next based on the patient's clinical and the tumor's pathological characteristics. Based on a review of the literature, the most important prognostic factors for recurrence are the prior recurrence rate, number of tumors, and tumor size; whereas for progression, the most important prognostic factors are the T category, grade, and presence of CIS. Treatment with intravesical bacillus Calmette-Guerin reduces both the risk of recurrence and the risk of progression, and is the treatment of choice in high-risk papillary tumors and in patients with CIS. Assessment of a patient's prognostic factors and his or her risk of recurrence and progression is a prerequisite for determining the most appropriate treatment and frequency of follow-up for a given patient.