Treatments for recurrent bladder cancer

Recurrent bladder cancer means that the cancer has come back after it has been treated. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.

How recurrent bladder cancer is treated depends on many factors, including:

  • where the cancer comes back
  • the treatments you’ve already had
  • when it comes back after initial treatment
  • if the treatments didn’t work and the cancer continues to grow (called treatment failure)
  • the grade

The following are treatment options for recurrent bladder cancer.

Non-invasive or non-muscle-invasive recurrence

A non-invasive recurrence is only in the inner lining of the bladder. A non-muscle-invasive recurrence is in the connective tissue layer of the bladder. These types of recurrence may also be called a local recurrence.

Treatments often depend on if the recurrence happens soon after treatment or later. If the cancer comes back 6 to 12 months after treatment, it is called an early recurrence. If the cancer comes back 12 months or more after treatment, it is called a late recurrence.

Non-invasive and non-muscle-invasive recurrences are treated the same as early stage bladder cancer.

Find out more about treatments for early stage bladder cancer.

Muscle-invasive or locally advanced recurrence

A muscle-invasive recurrence is when the cancer has grown into the muscle layer of the bladder. A locally advanced recurrence is in the tissue or organs just outside the bladder or in nearby lymph nodes.

Surgery

Surgery may be used to treat muscle-invasive and locally advanced recurrences. It is usually done if you were treated with a bladder-preserving approach and the bladder wasn’t removed.

A radical cystectomy removes the whole bladder and sometimes tissue and organs surrounding the bladder. Urinary diversion surgery is needed once the bladder is removed.

A urinary diversion makes a new way to hold urine (pee) and pass it out of the body. It is done after a radical cystectomy. A urinary diversion may also be done if there is a blockage and urine can’t leave the body.

A pelvic lymph node dissection (PLND) removes lymph nodes from the pelvis. It is done following a radical cystectomy, usually during the same surgery.

A transurethral resection of bladder tumour (TURBT) removes tumours from the bladder through the urethra. It may be done to control symptoms when a cystectomy can’t be done.

Chemotherapy

Chemotherapy is usually offered for muscle-invasive and locally advanced recurrences. It may be given as a part of chemoradiation if radiation therapy wasn’t already used.

Chemotherapy is usually given as a systemic therapy. If the cancer comes back more than 12 months after treatment, a combination of chemotherapy drugs that includes cisplatin is commonly used. If the cancer comes back within 12 months of treatment, immunotherapy is used instead.

Radiation therapy

You may be offered external radiation therapy for muscle-invasive and locally advanced recurrences. It may be given as a part of chemoradiation. External radiation therapy may also be used alone if surgery can’t be done.

Immunotherapy

You may be offered immunotherapy for a locally advanced recurrence. An immune checkpoint inhibitor is an immunotherapy drug that may be used if the cancer comes back within 12 months of finishing chemotherapy that includes cisplatin.

The immune checkpoint inhibitors that may be used are:

  • pembrolizumab (Keytruda)
  • durvalumab (Imfinzi)
  • atezolizumab (Tecentriq)
  • avelumab (Bavencio)

Monoclonal antibodies

Enfortumab vedotin (Padcev) is a type of monoclonal antibody. You may be offered enfortumab vedotin if you have recurrent bladder cancer that has already been treated with cisplatin or carboplatin and a PD-1 or PD-L1 immune checkpoint inhibitor. It may also be a treatment option if you can't be treated with cisplatin or carboplatin.

Distant recurrence

A distant recurrence means the cancer comes back in another part of the body. It is also called metastatic bladder cancer.

Find out more about treatments for metastatic bladder cancer.

If you can’t have or don’t want cancer treatment

You may want to consider a type of care to make you feel better without treating the cancer itself. This may be because the cancer treatments don’t work anymore, they’re not likely to improve your condition or they may cause side effects that are hard to cope with. There may also be other reasons why you can’t have or don’t want cancer treatment.

Talk to your healthcare team. They can help you choose care and treatment for advanced cancer.

Clinical trials

Talk to your doctor about clinical trials open to people with bladder cancer in Canada. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.

Expert review and references

  • Alberta Health Services . Muscle Invasive and Locally Advanced/Metastatic Bladder Cancer Clinical Practice Guideline GU-002 (Version 5) . Alberta Health Services ; 2013 : https://www.albertahealthservices.ca/.
  • Alberta Health Services . Nonmuscle Invasive Bladder Cancer Clinical Practice Guideline GU-009 (Version 1) . Alberta Health Services ; 2013 : https://www.albertahealthservices.ca/.
  • American Cancer Society . Treating Bladder Cancer . 2016 : https://www.cancer.org/.
  • American Society of Clinical Oncology . Bladder Cancer . 2017 : https://www.cancer.net/.
  • Cancer Care Ontario . Bladder Cancer Diagnosis, Treatment and Follow-up Care Pathway Map (Version 2017.02) . 2017 : https://www.cancercareontario.ca/en.
  • Chang SS, Bochner BH, Chou R, et al . Treatment of non-metastatic muscle-invasive bladder cancer: AUA/ASCO/ASTRO/SUO Guideline . Journal of Urology . 2017 .
  • Chang SS, Boorjian SA, Chou R, et al . Diagnosis and treatment of non-muscle invasive bladder cancer: AUA/SUO Guideline . Journal of Urology . 2016 .
  • Drugs and Health Products, Health Canada. Regulatory Decision Summary: Keytruda. 2017: https://hpr-rps.hres.ca/reg-content/regulatory-decision-summary-detail.php?lang=en&linkID=RDS00286.
  • Drugs and Health Products, Health Canada. Summary Basis of Decision (SBD) for IMFINZI. 2018: https://hpr-rps.hres.ca/reg-content/summary-basis-decision-detailTwo.php?linkID=SBD00384.
  • Drugs and Health Products, Health Canada . Qualifying Notice: Bavencio . 2018 .
  • Feldman AS, Efstathiou JA, Lee RJ, Dahl DM, Michaelson MD, Zietman AL . Cancer of the bladder, ureter, and renal pelvis. DeVita VT Jr, Lawrence TS, Rosenberg SA. Cancer: Principles and Practice of Oncology. 10th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2015: 65:896-916.
  • Finelli A, Brown J, Flood T, Kulkarni G, Hotte S, O’Malley M and the Genitourinary Cancer Advisory Committee, Cancer Care Ontario. Cancer Care Ontario Bladder Cancer Guideline 3-21: An Endorsement of the 2017 American Urological Association Treatment of Non-Metastatic Muscle-Invasive Bladder Cancer - AUA, ASCO, ASTRO, SUO Guideline. 2018.
  • National Cancer Institute . Bladder Cancer Treatment (PDQ®) Health Professional Version . 2018 : https://www.cancer.gov/.
  • National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Bladder Cancer (Version 5.2018).
  • Penn Medicine . All About Bladder Cancer . University of Pennsylvania ; 2017 : https://www.oncolink.org/.
  • Seagen Canada Inc.. Product Monograph: PADCEV.