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Answer 4
  1. Adjuvant chemotherapy. Adjuvant chemotherapy with CISCA (cisplatin, cyclophosphamide, doxorubicin), MVAC, or MVEC (methotrexate, vinblastine, cisplatin, epirubicin) has been shown to improve the outcome of patients with TCC of the bladder, although the number of patients enrolled in these studies was small, and the methodology has been called into question.13,14 In addition, the benefits of neoadjuvant chemotherapy have been well documented.8-10 Therefore, most genitourinary oncologists recommend adjuvant therapy in patients with a poor prognosis who have not undergone chemotherapy prior to surgery. PET is not indicated for staging of bladder cancer.

    8. Neoadjuvant cisplatin, methotrexate, and vinblastine chemotherapy for muscle-invasive bladder cancer: a randomised controlled trial. International Collaboration of Trialists [published erratum appears in Lancet 1999;354:1650]. Lancet 1999;354:533-40.

    9. Grossman HB, Natale RB, Tangen CM, et al. Neoadjuvant chemotherapy plus cystectomy compared with cystectomy alone for locally advanced bladder cancer [published erratum appears in N Engl J Med 2003;349:1880]. N Engl J Med 2003;349:859-66.

    10. Advanced Bladder Cancer Overview Collaboration. Neoadjuvant chemotherapy for invasive bladder cancer. Cochrane Database Syst Rev 2005;(2):CD005246.

    13. Skinner DG, Daniels JR, Russell CA, et al. The role of adjuvant chemotherapy following cystectomy for invasive bladder cancer: a prospective comparative trial. J Urol 1991;145:459-64.

    14. Stöckle M, Meyenburg W, Wellek S, et al. Advanced bladder cancer (stages pT3b, pT4a, pN1 and pN2): improved survival after radical cystectomy and 3 adjuvant cycles of chemotherapy. Results of a controlled prospective study. J Urol 1992;148:302-6.

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