Natural biology and management of nonmuscle invasive bladder cancer

Active Surveillance in Non-Muscle Invasive Bladder Cancer, the Potential Role of Biomarkers: A Systematic Review

Bladder cancer (BC) is the tenth most common cause of cancer worldwide and is the thirteenth leading cause of cancer mortality. The non-muscle invasive (NMI) variant represents 75% of cases and has a mortality rate of less than 1%; however, it has a high recurrence rate. The gold standard of management is transurethral resection in the case of new lesions. However, this is associated with significant morbidity and costs, so the reduction of these procedures would contribute to reducing complications, morbidity, and the burden to the health system associated with therapy. In this clinical scenario, strategies such as active surveillance have emerged that propose to manage low-risk BC with follow-up; however, due to the low evidence available, this is a strategy that is underutilized by clinicians. On the other hand, in the era of biomarkers, it is increasingly known how to use them as a tool in BC. Therefore, the aim of this review is to provide to clinical practitioners the evidence available to date on AS and the potential role of biomarkers in this therapeutic strategy in patients with low-grade/risk NMIBC. This is the first review linking use of biomarkers and active surveillance, including 29 articles.

MicroRNA-195 inhibits epithelial-mesenchymal transition via downregulating CDK4 in bladder cancer

Bladder cancer is one of the most common cancers in the world. Despite advanced development made to improve the diagnosis and therapy techniques for bladder cancer, patients always have a poor outcome based on its high potential for metastasis. MiR-195 was reported to have close relevance with the process of bladder cancer. However, the molecular mechanism of miR-195 underlying bladder cancer metastasis and epithelial-mesenchymal transition (EMT) remains unclear. The present study was done to explore the function of miR-195 on EMT and cell migration in bladder cancer. In the present study, we detected the level of miR-195 in 25 matched human bladder cancer tissues and normal adjacent tissues, as well as bladder cancer cell lines or normal cells. Additionally, we determined the effects of miR-195 on expression of CDK4, and the miR-195/CKD4 signaling cascade on cell cycle, invasion, migration, and viability. Results showed that miR-195 was down expressed in bladder cancer tissues and cell lines, which inhibited EMT, cell migration, and invasion. We identify CDK4, an early G1 cell cycle regulator, as a downstream target of miR-195. Also, we found that miR-195 could induce G1-phase arrest, inhibit cell invasion, migration, and viability through down-regulation of CDK4 expression in 5637 and BIU-87 cells. Our experimental data suggest an important role for miR-195/CDK4 in bladder tumorigenesis and provide a potential therapeutic strategy for bladder cancer.

New developments in the management of nonmuscle invasive bladder cancer

PURPOSE OF REVIEW

In this review, we summarize the core principles in the management of nonmuscle invasive bladder cancer (NMIBC) with an emphasis on new developments that have emerged over the last year.

RECENT FINDINGS

NMIBC has a propensity to recur and progress. Risk stratification has facilitated appropriate patient selection for treatment but improved tools, including biomarkers, are still needed. Enhanced cystoscopy with photodynamic imaging and narrow band imaging show promise for diagnosis, risk stratification, and disease monitoring and has been formally recommended this year by the American Urological Association. Attempts at better treatment, especially in refractory high-risk cases, include the addition of intravesical hyperthermia, combination and sequential therapy with existing agents, and the use of novel agents such as mycobacterial cell wall extract. New data are emerging regarding the potential role of early cystectomy in bacillus Calmette-Guerin-refractory NMIBC patients.

SUMMARY

NMIBC represents an assortment of disease states and continues to pose management challenges. Continued research is needed to bolster the evidence needed for patients and providers to make data-driven treatment decisions.