A RECENT prospective observational cohort study known as the CISTO Study has shed light on the comparative effectiveness of radical cystectomy (RC) and bladder-sparing therapy (BST) for patients with recurrent high-grade non-muscle invasive bladder cancer (NMIBC). Conducted across 36 academic and community urology practices in the United States, the study included 570 patients, of whom 371 opted for BST and 199 chose RC. The trial was designed with input from patients, clinicians, and stakeholders to evaluate outcomes that matter most to those affected.
At the 12-month mark, physical function scores, the primary outcome measured by the EORTC-QLQ-C30 tool, showed no significant overall difference between the two treatment groups. However, subgroups such as patients without a caregiver or those with carcinoma in situ experienced slightly better physical function outcomes following RC. Additionally, RC was associated with improved results in several other health domains, including global health, emotional and cognitive function, depression, anxiety, and financial toxicity, when compared with BST.
Despite these advantages, RC was linked with poorer outcomes in bowel and sexual health, and there were no notable differences in social and role function or urinary health between the two groups. Notably, 22% of patients who underwent RC were upstaged at surgery, leading to a lower 12-month progression-free survival rate (73% in RC vs 92% in BST). However, cancer-specific survival was comparable between groups, with 99% for BST and 96% for RC.
These findings highlight the nuanced trade-offs between RC and BST. While RC may offer broader quality of life benefits and emotional well-being for certain patients, particularly those lacking caregiver support or with specific disease characteristics, it also carries risks, including worse sexual and bowel function and a higher likelihood of upstaging. The study reinforces the ongoing role of RC in treating recurrent high-risk NMIBC and emphasises the importance of shared decision-making, considering both clinical outcomes and patient-centred priorities. Continued follow-up will be essential to assess long-term impacts of these treatment pathways.
Reference
Gore JL et al. Radical cystectomy versus bladder-sparing therapy for recurrent high-grade non-muscle invasive bladder cancer: results from the Comparison of Intravesical Therapy and Surgery as Treatment Options (CISTO) study. J Urol. 2025;DOI:10.1097/01.JU.0001111604.90306.91.
