1781 WHAT IS THE RISK OF HIGH RISK NON-MUSCLE INVASIVE BLADDER CANCER? AN ENGLISH CANCER NETWORK EXPERIENCE

Abstract

You have accessJournal of UrologyBladder Cancer: Superficial II1 Apr 20121781 WHAT IS THE RISK OF HIGH RISK NON-MUSCLE INVASIVE BLADDER CANCER? AN ENGLISH CANCER NETWORK EXPERIENCE Omar Al Kadhi, Robert Mills, Mark Rochester, Alexandra Colquhoun, David Neal, and William Turner Omar Al KadhiOmar Al Kadhi Cambridge, United Kingdom More articles by this author , Robert MillsRobert Mills Norwich, United Kingdom More articles by this author , Mark RochesterMark Rochester Norwich, United Kingdom More articles by this author , Alexandra ColquhounAlexandra Colquhoun Cambridge, United Kingdom More articles by this author , David NealDavid Neal Cambridge, United Kingdom More articles by this author , and William TurnerWilliam Turner Cambridge, United Kingdom More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1798AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES High risk non-muscle invasive bladder cancer (HRNMIBC) carries a high risk of progression, and a decreased probability of survival. There is often an understandable reluctance on behalf of patients and treating urologists to submit to early radical cystectomy (RC), in favor of intravesical Bacillus Calmette-Guérin (BCG) treatment. With the advent of centralization of cancer care in English cancer networks, all RC are now performed in cancer centers. We assessed understaging of HRNMIBC in all RC done in two cancer networks between January 2008 and September 2011 avoiding the selection bias inherent in previously published series. METHODS Data on all patients undergoing RC performed in two tertiary referral centers were retrospectively reviewed. We determined the rate of muscle invasion in patients undergoing RC as first treatment (primary RC) for HRNMIBC and also in patients undergoing RC for BCG failure. We also examined the outcomes in patients with and without pre-cystectomy bladder carcinoma in situ (Tis). RESULTS A total of 120 RC procedures for presumed HRNMIBC were carried out in the two centers during the 45 month period. There were 103 men. The median age was 70 years (range 46-85). Primary RC was done in 47 patients, and RC was done in 73 patients who had failed intravesical BCG. Ten of 47 (21%) patients in the primary RC group and 19 of 73 (26%) patients in the BCG failure group were upstaged to at least pT2 disease. In the primary RC group, six patients (13%) had Tis; none were upstaged at cystectomy. In contrast, 32 patients with Tis underwent RC after failed BCG treatment (44%) and in 10 out of 32 (31%) muscle invasion was evident following RC. CONCLUSIONS In our comprehensive unselected series from two English cancer networks 1 in 5 patients who had primary RC for HRNMIBC had unsuspected muscle invasive bladder cancer; in patients who failed BCG, 1 in 4 had unsuspected muscle invasion. The highest risk of upstaging across this whole cohort was in those patients who had failed BCG and who had Tis. All patients with newly diagnosed HRNMIBC should be seen by a urologist with expertise in RC and advised that they should at least consider RC because of their high risk of unsuspected muscle invasive cancer. Patients who opt for BCG but fail, should see a cystectomy specialist promptly, because their risk of unsuspected muscle invasive cancer maybe even higher. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e719 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Omar Al Kadhi Cambridge, United Kingdom More articles by this author Robert Mills Norwich, United Kingdom More articles by this author Mark Rochester Norwich, United Kingdom More articles by this author Alexandra Colquhoun Cambridge, United Kingdom More articles by this author David Neal Cambridge, United Kingdom More articles by this author William Turner Cambridge, United Kingdom More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...