Investigational Treatment for this stage is becoming controversial. Since most patients do not do well with cystectomy alone, many investigators are entering patients into clinical trials that will answer the important question of how effective neoadjuvant therapy is in increasing survival.
• Two protocols under investigation are: chemotherapy with M-VAC versus no chemotherapy before
cystectomy; and CMV chemotherapy versus no chemotherapy before external beam radiation therapy .
Preliminary results suggest that patients downstaged from a T3 to a much lower stage tumor fare better.
Patients are urged to participate in these studies so that correct answers to the true value of neoadjuvant
therapy can be discovered.
Stage IV or D
TNM T4, N0, M0
Any T, N1-3, M0
Any T, any N, M1
The tumor invades adjacent organs such as the prostate, uterus and vagina alone (T4a, N0, M0 / D1), or it spreads to the pelvic bone and abdominal wall (T4b, N0, M0 / D1), to pelvic lymph nodes (any T, N1-3, M0 / D1), to abdominal lymph nodes (any T, N4, M0 / D2) or to other organs (any T, any N, M1 / D2).
