Bladder cancer can be treated without removal for select patients, says Saudi specialist

A Saudi specialist has said that preserving the bladder is a viable treatment option for certain patients with muscle-invasive bladder tumors, by combining endoscopic resection with chemotherapy and radiotherapy. He also noted the expanding role of immunotherapy, depending on the stage of the disease and patient eligibility.

Dr. Saad Al-Rashidi, consultant in radiation oncology, who delivered a lecture on the “Algorithm for Bladder Cancer Treatment” at the 7th Annual Emirates Oncology Society Conference (EOS 2026), recently held at the InterContinental Dubai Festival City, emphasized that treatment selection relies on accurate tumor staging, assessment of tumor characteristics and patient health, and multidisciplinary team discussions.

Al-Rashidi explained that the treatment plan begins with maximal endoscopic tumor resection, followed by tissue analysis to determine the depth of invasion, and further evaluation of disease stage and the upper urinary tract. These results distinguish between non–muscle-invasive, muscle-invasive, and metastatic bladder cancers, each requiring a different treatment pathway.

For non–muscle-invasive tumors, he said that risk stratification is key to choosing therapy. Bacillus Calmette–Guérin (BCG), administered directly into the bladder to stimulate an immune response, remains the standard for high-risk cases. According to clinical guidelines, low-risk cases are managed with endoscopic resection and a single dose of intravesical chemotherapy after surgery if there are no contraindications, followed by regular monitoring.

He discussed options for tumors unresponsive to BCG, including radical cystectomy and alternatives for patients who decline or are unfit for surgery. Guidelines recommend radical cystectomy for eligible patients in this group, while bladder-sparing strategies may be considered for others, preferably within clinical trials.

Regarding muscle-invasive tumors, Al-Rashidi reviewed advances in perioperative drug therapy. Recent approaches include adding immunotherapy to chemotherapy before surgery, then continuing immunotherapy postoperatively for eligible patients, as well as combining immunotherapy with antibody-drug conjugates for certain groups. These conjugates deliver anti-cancer drugs directly to targeted cells, distinguishing them from therapies aimed at specific genetic mutations.

He highlighted the use of circulating tumor DNA (ctDNA) blood tests in post-surgical disease assessment and in guiding adjuvant therapy decisions, by detecting residual disease that may not appear on imaging.

For bladder preservation, Al-Rashidi described the trimodality approach, which combines maximal endoscopic tumor resection with radiotherapy and concurrent chemotherapy to increase cancer cell sensitivity to radiation. This is a guideline-supported option for select patients.

He stressed the importance of multidisciplinary team discussions, follow-up planning, and response assessment, with readiness to perform salvage surgery if needed. He also noted the role of advanced radiotherapy techniques and daily imaging in improving treatment precision, and emphasized adherence to treatment schedules to avoid unnecessary interruptions.

Al-Rashidi explained that radiotherapy also has other roles, such as post-cystectomy use in high-risk patients to improve local and lymph node control, and for symptom relief in tumor-related cases.

For metastatic or advanced inoperable disease, he said drug therapy is the first-line approach, and that combining immunotherapy with antibody-drug conjugates has become a preferred option for eligible patients. The team may later consider surgery or radiotherapy in select cases, depending on response, disease spread, and treatment goals.

He also pointed out the importance of testing for genetic alterations in the tumor when selecting subsequent lines of therapy, to identify patients who may benefit from targeted drugs, while considering prior treatments and the patient’s overall condition.