1829 RADICAL CYSTECTOMY AFTER BCG: HAS THE TIMING OF SURGERY IMPROVED IN RECENT YEARS?

Abstract

You have accessJournal of UrologyBladder Cancer: Invasive/Metastatic Disease III1 Apr 20101829 RADICAL CYSTECTOMY AFTER BCG: HAS THE TIMING OF SURGERY IMPROVED IN RECENT YEARS? Mohan Arianayagam, Devendar Katkoori, Kristell Acosta, Murugesan Manoharan, and Mark Soloway Mohan ArianayagamMohan Arianayagam More articles by this author , Devendar KatkooriDevendar Katkoori More articles by this author , Kristell AcostaKristell Acosta More articles by this author , Murugesan ManoharanMurugesan Manoharan More articles by this author , and Mark SolowayMark Soloway More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1767AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Intravesical BCG is commonly used to treat patients with high grade Ta, T1 and CIS bladder cancer (BC). Since BCG is not uniformly effective, it is of utmost importance that patients receiving BCG are evaluated carefully and immunotherapy should be abandoned in favor of a radical cystectomy (RC) at the earliest evidence of high grade recurrrence. The timing of RC is crucial given that the survival following RC is directly related to the pathologic stage. If RC is performed before progression to muscle invasion (<pT2), as is the case when BCG is first initiated, the cancer specific survival is over 90%. However, the 5-yr survival declines to less than 70% for muscle invasive BC. With increasing data and awareness on BCG failure in the past few years, it is anticipated that the timing of RC will improve and more patients will undergo RC before adverse pathologic progression. In this study we analyzed if there was a trend in recent years towards performing RC at an earlier stage. METHODS A retrospective analysis of our RC database was performed to identify patients who underwent RC after BCG treatment. The majority of patients were referred by community urologists for evaluation and treatment following one or more courses of BCG for non muscle invasive BC. Relevant clinical and pathological data were analyzed. The final pathologic stage for patients who underwent RC from 2003 to 2007 (group 1) was compared to a those operated between 1992 and 2002 (group 2). RESULTS 152 patients were included, 75 in group 1 and 77 in group 2. The groups were similar in tumor stage prior to initiation of BCG, number of BCG cycles and time interval from first BCG to RC. Patients receiving neoadjuvant chemotherapy were excluded. The proportion of patients with <pT2 BC has remained the same (p=0.5).52% of group1 and 43% of group 2 had ≥pT2 BC with 32% and 26% having extravesical BC (pT3/ pT4). 16% of group1 and 11% in group2 were N+. CONCLUSIONS The timing of RC has not improved in recent years. A high proportion of patients undergoing RC after receiving BCG have pT2 or higher BC. A bladder preservation approach should be discontinued at the first indication of persistent or recurrent high grade BC. Miami, FL© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e709-e710 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mohan Arianayagam More articles by this author Devendar Katkoori More articles by this author Kristell Acosta More articles by this author Murugesan Manoharan More articles by this author Mark Soloway More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...