The true natural history of bladder cancer is relatively unknown, because virtually all bladder cancers become clinically evident and are treated. As outcome is far less favorable with advanced local and metastatic disease, many recent studies have tried to define histologic and molecular predictors of aggressive tumor behavior (e.g. muscle invasion) and to identify those patients at high risk for developing muscle-invasive disease. Promising preliminary results from early detection and screening studies await confirmation in randomized, prospective trials.
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