Recurrence in Bladder Cancer: A Molecular Dead End?

Transitional cell carcinomas of the urinary bladder are frequently characterised by multiple local recurrences with a low risk of progression. The observation that a significant proportion of patients experience recurrences over many years, even decades, without ever developing aggressive life threatening disease has led to the hypothesis that recurrence is a separate clinical and molecular event in the natural history of this disease. Over recent years a number of studies have been undertaken to test this hypothesis and within the last 12-24 months candidate loci and genes have been identified which may represent such recurrence related molecular events. Within this review we have summarised the data which identifies three key loci on chromosome 9q34, 11q23 and 17q25 as associated with recurrence and sought to place these findings in the context of a multistage molecular model of bladder cancer initiation, recurrence, progression and metastasis.