Uncertainty and outcome of invasive bladder tumors

The uncertainty principle articulated by Heisenberg that natural events cannot be measured precisely without changing their behavior is a metaphor for understanding outcomes of bladder tumors. A transurethral resection (TUR) ideally determines if a tumor is invasive and whether such invasion is confined to the bladder. Prognosis is determined by the pathologic extent of the tumor, but TUR creates uncertainty because it may completely remove or downstage the neoplasm. Tumors that are downstaged following TUR have a better outcome after cystectomy than predicted by the TUR findings, whereas tumors that are confined or not confined to the bladder muscle have a prognosis that is either equal to or worse than predicted by the TUR. A repeat biopsy after the first TUR may reduce the uncertainty of depth of muscle infiltration and permit some tumors to be cured with bladder preservation as well as improve the outcome of those that require cystectomy.