SUPERFICIAL URINARY-BLADDER CANCER - RESULTS FROM THE FINNBLADDER STUDIES AND A REVIEW ON INSTILLATION TREATMENTS

At present, about 80 % of primary, newly diagnosed urinary bladder can cers are local (NOMO), i.e., potentially curable. Not less than two th irds of all are superficial cancers (TIS, Ta, T1), and thus subjects o f conservative, local treatments. Carcinoma in situ (TIS/CIS) has thre e clinical manifestations: 1) primary TIS is found without a previous history of bladder cancer, 2) secondary TIS is found during the follow -up of an earlier cancer, and 3) concomitant TIS is found simultaneous ly with a papillary tumour. Otherwise, there are controversial diagnos tic and therapeutic attitudes on TIS. Concerning the primary diagnosis and grading, the reliance on cytological possibilities varies in sepa rate centres. ''Wait-and-see policy'' might be justified in mild dyspl asia Grade 1, whereas both the TIS Grade 2, and TIS Grade 3, are real malignancies which need a more effective treatment than transurethral resection (TUR) alone. Under a close control, intravesical chemo- and immunotherapy with doxorubicin (ADM), mitomycin C (MMC) and bacillus C almette-Guerin (BCG) offer an alternative to cystectomy. However, it r emains to be seen in the future whether combined or alternating instil lations will give a still better return. By contrast, the principal tr eatment of visible superficial (Ta and T1) cancer is TUR, which can be easily repeated. Most recommended strategy for Grade 3 T1 cancer seem s to be the same. Anyhow, the high frequency of recurring tumours and the tendency to simultaneous progression in specific categories of Ta- T1 cancer have led to adjuvant prophylactic instillation treatments. C urrently, both local cytostatics (ADM and MMC in the present series), and immunoagents (BCG) have been proven safe. In our series, MMC is sl ightly better than ADM, and BCG seems superior to other agents in effi cacy. It is obvious that the future of the prophylaxis focuses on comb ined or alternating treatments. We review our experiences on instillat ion treatments of superficial bladder cancer since 1976, and outline t he forthcoming studies.