The
clinical course for both early and late stage
Bladder Cancer (BC) continues to be characterized by significant patient burden due to numerous occurrences and recurrences requiring frequent surveillance strategies, intravesical
drug therapies, and even more aggressive treatments in patients with locally advanced or metastatic disease. For these reasons, BC is also the most expensive
cancer to treat. Fortunately, BC offers an excellent platform for
chemoprevention interventions with potential to optimize the systemic and local exposure of promising agents to the bladder mucosa. However, other than smoking cessation, there is a paucity of research that systematically examines agents for
chemoprevention of
bladder cancers. Adopting a systematic, molecular-mechanism based approach, the goal of this review is to summarize epidemiological, in vitro, and preclinical studies, including data regarding the safety, bioavailability, and efficacy of agents evaluated for
bladder cancer chemoprevention. Based on the available studies,
phytochemicals, specifically
isothiocyanates such as
sulforaphane, present in Brassicaceae or "cruciferous" vegetables in the precursor form of
glucoraphanin are: (a) available in standardized formulations; (b) bioavailable- both systemically and in the bladder; (c) observed to be potent inhibitors of BC
carcinogenesis through multiple mechanisms; and (d) without toxicities at these doses. Based on available evidence from epidemiological, in vitro, preclinical, and early phase trials,
phytochemicals, specifically
isothiocyanates (ITCs) such as
sulforaphane (SFN) represent a promising potential chemopreventitive agent in
bladder cancer.