38 8.4: Future Directions

The common problem between conventional and novel treatment approaches is that a high recurrence rate remains a possibility. While it has been established that high recurrence is concerning after radical cystectomy and urinary diversions, the new research on stem-cell based therapies show that recurrence remains a problem. Because this seems to be the most important issue, it would be beneficial to investigate ways in which recurrence can be reduced.

Since radical cystectomy and urinary diversions are still a common treatment option for bladder cancer patients, it is crucial that appropriate measures be taken to reduce the likelihood of recurrence as much as possible. Residual urethra is known to be a common site for recurrence, and several risk factors need to be taken into account, such as pathological staging (Li et al. 2793-94). From this, it is immediately apparent that proper protocol should be established to ensure that diagnoses are completed as early as possible.

With regards to novel tissue-engineering approaches, it is essential to further study the details behind the interactions between adipose-derived stem cells and bladder cancer cells. Currently, it is known that adipose-derived stem cells promote an environment that can increase the proliferation, viability, and invasiveness of bladder cancer cells (Maj et al. 10). However, it is unknown as to why adipose-derived stem cells interact with the pathways that induce this expression. In order for tissue-engineering to be a viable option, more research needs to be done to not only determine the mechanism behind the crosstalk of adipose-derived stem cells and bladder cancer cells, but also ways in which these mechanisms can be inhibited.

In addition to the possible recurrence of cancer due to an induced, tumour-proliferating, environment, another important factor to consider for tissue-engineering is the cytotoxicity of urine. Adipose-derived stem cells are very sensitive to urine, and thus cause a problem for cell seeded graft implants in the urinary system (Pokrywczyńska et al. 2307). While new designs of implants are being developed to combat this problem, several other issues arise as well, such as stone formation (Wang et al. 11). These new designs are well-suited in animal models, so the goal is to construct the best possible design of urinary implants that allows for efficient treatment in a clinical setting.