Bladder tumours: time for a paradigm shift?

The results for many types of cancers have improved during later decades but not so for bladder cancer. Most patients with muscle-invasive tumors will still succumb to the disease and a high recurrence rate characterises non-muscle invasive tumors.The objective is to critically review the present model of bladder cancer based on newly acquired biological data. The definition of bladder cancer has extended with the introduction of the WHO classification. The corresponding loss of distinction between benign tumor and cancer has not been rewarding and should be reintroduced to facilitate exploration of new molecular findings. The common endpoints recurrence and progression should be redefined or replaced by more appropriate endpoints. The concept of surgery only for locally advanced cancers has proven unsuccessful and has to be complemented with early administered systemic treatment.