Bladder Cancer: Current Perspectives and Therapeutic Challenges

Bladder cancer is a common urothelial neoplasm that presents significant clinical challenges, mainly due to its high recurrence rate, potential for progression, and impact on quality of life.Non-muscle-invasive bladder cancer (NMIBC) accounts for the majority of cases and is treated by transurethral resection followed by intravesical therapies, such as BCG immunotherapy.Muscle-invasive bladder cancer (MIBC), on the other hand, requires a more aggressive approach, with radical cystectomy combined with neoadjuvant chemotherapy being the gold standard.Trimodal therapy has established itself as an effective alternative to cystectomy in selected patients, promoting bladder preservation.Advances in the molecular classification of urothelial carcinoma have allowed the identification of subtypes with distinct prognostic and therapeutic characteristics, enabling personalized approaches.However, challenges remain, such as resistance to BCG, the selection of patients for conservative therapies, and the management of patients who are ineligible for cisplatin.Precision medicine, based on molecular biomarkers, is emerging as promising in the personalization of treatment and the optimization of oncological outcomes.