A 55-year-old man with muscle-invasive bladder cancer (T2N0M0, transitional cell carcinoma) is planned for radical cystectomy. According to current guidelines, what is the recommended neoadjuvant approach?

• A Neoadjuvant intravesical BCG
• B Neoadjuvant immunotherapy with checkpoint inhibitor
• C Neoadjuvant radiotherapy
• D Neoadjuvant cisplatin-based combination chemotherapy (MVAC or GC regimen) ✓

Explanation

For muscle-invasive bladder cancer (MIBC, T2-T4aN0M0), neoadjuvant cisplatin-based combination chemotherapy — either MVAC (methotrexate, vinblastine, doxorubicin, cisplatin) or GC (gemcitabine-cisplatin) — followed by radical cystectomy is the standard of care for cisplatin-eligible patients. Multiple randomized trials and meta-analyses have shown approximately 5-8% absolute improvement in 5-year survival with neoadjuvant chemotherapy. This approach also allows downstaging of disease and assessment of chemosensitivity, enabling personalized management. Intravesical BCG is used for non-muscle-invasive disease.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.