Personalized Bladder Cancer Management

Bladder cancer incidence in the Netherlands has increased over 1.5-fold since the 1990s, with currently over 7.000 new cases each year in the Netherlands. Over two thirds of new patients are diagnosed with NMIBC, the remaining one third of patients are diagnosed with MIBC. The 5-year survival of NMIBC patients is very good (>90%), however recurrence rates are high (>50%) and the disease may progress to MIBC. Consequently, NMIBC necessitates long and costly surveillance. On the other hand, the prognosis of MIBC is very poor; the 5-year survival rate is around 60% for stage T2 and only 6% for stage T4 disease 6. Treatment options for MIBC are limited and the survival rates have not improved much over the past 20 years, although recently introduced immune therapies present promising results. The high incidence and recurrence rate of NMIBC, together with the poor survival rate of MIBC and the immense costs make bladder cancer a serious public health problem.
The general aim of this thesis was to evaluate and validate the use of (epi)genetic biomarkers in personalized bladder cancer management; including diagnosis of primary disease, prognosis of disease, tools for treatment allocation and their use in individualized surveillance regimens.