After a bladder cancer diagnosis, you might worry about keeping your bladder and maintaining your quality of life. One treatment option for muscle-invasive bladder cancer (MIBC) is trimodality therapy (TMT). This treatment combines surgery, chemotherapy, and radiation therapy. Unlike some other treatments, TMT allows you to keep your bladder. Studies show this approach can be just as effective as other bladder cancer treatment options for certain individuals.

This article will discuss what trimodality therapy is and how it works. It will also compare trimodality therapy to radical cystectomy (surgical removal of the entire bladder) and explore why TMT may be the preferred option for some people. Finally, we’ll look at who is eligible for TMT. If you want to know more about this treatment or find out if it’s right for you, talk with your cancer care team.

What Is Trimodality Therapy?

After being diagnosed with bladder cancer, you’ll meet with your oncologist (a cancer specialist) to create a personalized treatment plan. For muscle-invasive bladder cancer, the standard treatment is often a radical cystectomy. This surgery involves removing the entire bladder and some nearby organs, such as the prostate or the ovaries and fallopian tubes.

Studies show that 70 percent of people treated with trimodality therapy keep their bladder and its function.

Many cancers are treated using multimodal therapy, which combines multiple treatments at the same time. For MIBC, an alternative to radical cystectomy is trimodality therapy.

Trimodality therapy is a bladder-sparing therapy, meaning it treats the cancer without removing the bladder. This option can help preserve bladder function and improve quality of life. Studies show that 70 percent of people treated with trimodality therapy keep their bladder and its function.

Trimodality therapy combines three approaches for treating MIBC:

• Maximal transurethral resection of bladder tumor (TURBT) — A surgical procedure to remove as much of the tumor as possible
• Chemotherapy — A medication that targets and destroys cancer cells throughout the body
• Radiation therapy (radiotherapy) — High-energy rays that directly kill cancer cells in the bladder and surrounding tissues

Trimodality therapy offers a balance between effective cancer treatment and preserving the bladder, making it an appealing choice for many people living with bladder cancer.

Maximal Transurethral Resection of Bladder Tumor

Trimodality therapy starts with maximal transurethral resection of bladder tumor. Doctors use TURBT to find and remove bladder tumors. The process uses a cystoscope — a long, thin tube with a camera and surgical tools attached to the end. Your doctor inserts the cystoscope into the urethra (the tube that carries urine from the bladder).

Before the procedure, you’ll receive general anesthesia (medicine to put you to sleep). Once the cystoscope is placed, your doctor will remove as much of the bladder tumor as possible. After TURBT, some people have a catheter (small tube to help drain urine) placed. Catheters can also reduce the risk of complications like blood clots or urinary retention (difficulty emptying the bladder) during recovery.

In most cases, trimodality therapy starts with maximal TURBT. Some people may get neoadjuvant chemotherapy (chemotherapy given before surgery) to shrink the tumor first. Researchers are still learning whether this approach helps improve TURBT outcomes.

Maximal TURBT is essential because removing as much of the tumor as possible reduces the cancer burden. This improves the effectiveness of chemotherapy and radiation therapy, increasing the chances of preserving bladder function.

Concurrent Chemotherapy and Radiation Therapy

After maximal TURBT, the next step is concurrent chemotherapy and radiation therapy, often called chemoradiation or sometimes chemoradiotherapy. “Concurrent” means the two treatments happen at the same time or close together.

Chemotherapy uses drugs to kill cancer cells throughout the body. Common medications include cisplatin, methotrexate, vinblastine, doxorubicin, and gemcitabine. For people who cannot tolerate cisplatin, alternatives like capecitabine or combinations with gemcitabine may be used. These medications target cancer cells in different ways, offering flexibility in treatment options.

Radiation therapy uses focused X-ray beams to damage cancer cell DNA, which prevents them from growing and dividing. Eventually, the cancer cells die off and the tumors shrink. Treating bladder cancer with chemotherapy makes the cells sensitive to radiation. This means that the treatment is more likely to work.

During concurrent chemotherapy and radiation therapy, you’ll follow a schedule. Most people have radiation therapy five days a week, or Monday through Friday. Treatment rounds last four to seven weeks. You’ll see a radiation oncologist (cancer specialist), who will manage your treatment plan.

At the same time, you’ll also have chemotherapy. You may need to go to an infusion clinic for a few hours every week or more. Other people take chemotherapy pills every day instead.

During and After Trimodality Therapy

Chemotherapy and radiation therapy can be intense, but maintaining open communication with your health care team can make a big difference. Both treatments can cause side effects like fatigue, nausea, or bladder irritation. Your care team can offer supportive care — including medications, dietary advice, and counseling — to help you manage these challenges and stick to your treatment plan.

After finishing trimodality therapy, it’s important to follow up with regular cystoscopies.

Like any surgery, maximal TURBT has some risks. Cleveland Clinic notes you may have discomfort or notice blood while urinating after your procedure. It’s also possible to develop a urinary tract infection (UTI). Some people have reactions to anesthesia. Be sure to tell your doctor about any allergies or problems before TURBT.

Side effects of chemotherapy include:

• Hair loss
• Fatigue or extreme tiredness
• Sores on your mouth and tongue
• Weight loss
• Nausea and vomiting
• Constipation or diarrhea
• Changes in your mood
• A higher risk of infections

During and after radiation therapy, you may experience:

• Fatigue, which can last a few weeks
• Dry, itchy, or irritated skin where the radiation was given
• Digestive problems, like diarrhea, nausea, or vomiting
• Trouble urinating

After finishing trimodality therapy, it’s important to follow up with regular cystoscopies. These checkups help your doctor monitor for signs of cancer returning. One of the key benefits of TMT is that it helps you preserve your bladder and its function. After treatment, you should still be able to urinate normally, just like you did before cancer.

Trimodality Therapy Is Effective for Bladder Cancer

For many years, the standard treatment for MIBC was bladder removal. Now, doctors recommend TMT for certain people to preserve the bladder while effectively treating cancer. Research shows that TMT is successful in many cases.

Trimodality therapy is usually used in older people with early-stage tumors.

One meta-analysis (a type of study that examines the results of many different individual studies) found that:

• Following trimodality therapy, 75 out of 100 people have no more signs of cancer.
• Five years after treatment, about 67 out of 100 people are still alive.

These results highlight that TMT can be a highly effective treatment option for people with bladder cancer, offering a chance to keep the bladder while maintaining good survival outcomes.

Trimodality Therapy vs. Radical Cystectomy

Studies have also compared trimodality therapy to radical cystectomy to determine the best treatment for MIBC. Research shows that some people respond better to TMT than others. TMT is often recommended for older people who have smaller, less invasive tumors, as these factors are linked to a better prognosis (expected outcome). Trimodality therapy works well when it’s given to the best candidates.

A systematic review and meta-analysis found no significant differences in survival in people who received trimodality therapy versus those who underwent radical cystectomy. However, the study did find that people treated with TMT had better quality-of-life scores. This is likely because TMT preserves the bladder, allowing people to maintain normal bladder function.

TMT also has the advantage of being less invasive than surgery, leading to fewer immediate physical and emotional challenges during recovery. While radical cystectomy remains the standard treatment for some cases, TMT is a valuable option for people looking to balance effective cancer treatment with maintaining their quality of life.

Who Is Eligible for Trimodality Therapy?

Not everyone with muscle-invasive bladder cancer can be treated with trimodality therapy. Your doctor may suggest the treatment if you meet certain criteria. For example, people with MIBC whose bladder still works well are often good candidates because their bladder is likely to function properly after treatment.

Hydronephrosis occurs when urine can’t flow from the kidneys to the bladder. The fluid backup causes swelling in the kidneys, potentially leading to damage. People without hydronephrosis tend to be better candidates for TMT because their bladder and kidney function are usually intact.

A radical cystectomy is a major surgery with significant recovery demands. For older people and those with comorbidities (other health problems), the risks of surgery and postsurgical complications may be too high. In these cases, doctors may recommend trimodality therapy as a less invasive option.

Work With Your Doctor

Trimodality therapy offers a promising alternative to radical cystectomy for treating MIBC, particularly for those who are good candidates. By preserving the bladder, TMT can help maintain quality of life while providing effective cancer control, with survival rates comparable to surgery in many cases. However, eligibility depends on factors like tumor size, bladder function, and overall health.

If you’re navigating treatment options for MIBC, speak with your doctor to weigh the benefits and risks of TMT and determine the best path forward for your needs and lifestyle.

Talk With Others Who Understand

MyBladderCancerTeam is the social network for people with bladder cancer and their loved ones. On MyBladderCancerTeam, members come together to ask questions, give advice, and share their stories with others who understand life with bladder cancer.

Have you received trimodality therapy? How did it help treat your bladder cancer? Share your experiences in the comments below, or start a conversation by posting on your Activities page.