Current and innovative approaches in the treatment of Non-Muscle Invasive Bladder Cancer: the role of TransUrethral Resection of Bladder tumor and organoids

Abstract

Bladder cancer (BC) is the 7th most common cancer in men. About 75 % of all BC are non-muscle invasive (NMIBC). The golden standard for definite diagnosis and first-line treatment of NMIBC is transurethral resection of bladder tumor (TURB). Historically, the monopolar current was used first, today bipolar current is preferred by most urologists. Following TURB, depending on the tumor grade, additional intravesical chemo- or/and immunotherapy is indicated, in order to prevent recurrence and need for surgical resection. Development of new technologies, molecular and cell biology, enabled scientists to develop organoids - systems of human cells that are cultivated in the laboratory and have characteristics of the tissue from which they were harvested. In the field of urologic cancers, the organoids are used mainly for studying the course of different diseases, however, in the field of bladder cancer the data are scarce.

Since in the literature, there is no data about the effect of different currents - monopolar and bipolar on urothelium, and these data are important for the assessment of the specimen, here we review different TURB modalities. We describe the potential use of bladder biopsies obtained by monopolar or biopolar currents for the preparation of organoids and application of such organoids for studying carcinogenesis. The possible application of organoids in personalized medicine, as a method to first and foremost check the effectiveness of chemo-/immunotherapeutics in patients with bladder cancer is also discussed. 

Keywords: bladder cancer, transurethral resection of bladder tumor (TURB), monopolar/bipolar current, organoids, mitomycin C (MMC), BCG