American Board of Internal Medicine (ABIM) Certification Practice Exam

For patients with muscle-invasive bladder cancer, which treatment option is recommended?

1. Cystoscopic biopsy only

2. Neoadjuvant cisplatin-based chemotherapy

3. Immediate radical cystectomy

4. Radiation therapy only

The correct answer is: Neoadjuvant cisplatin-based chemotherapy

The recommended treatment option for patients with muscle-invasive bladder cancer is neoadjuvant cisplatin-based chemotherapy. This approach is favored because it addresses the cancer systemically prior to any surgical intervention. Neoadjuvant chemotherapy aims to reduce the tumor size, potentially making subsequent surgical procedures more successful and increasing the likelihood of preserving bladder function in some cases. Studies have shown that administering chemotherapy before surgery can significantly improve overall survival rates compared to immediate surgical intervention alone. This strategy allows for early treatment of micro metastases that may not be detected at the time of surgery, helping to lower the risk of recurrence after surgical removal of the bladder. In contrast, cystoscopic biopsy is a diagnostic procedure and does not provide treatment for the cancer, while immediate radical cystectomy, although a standard treatment approach, does not incorporate the benefits of pre-surgical systemic therapy as neoadjuvant chemotherapy does. Radiation therapy alone is typically not considered sufficient for treating muscle-invasive bladder cancer, as it does not target the disease as effectively as cisplatin-based chemotherapy in this context.