Incidence Of Bladder Cancer Research Articles

Impact of finasteride on modulating the risk and clinical outcomes of bladder cancer: insights from a comprehensive meta-analysis

PurposeNumerous prior analyses have highlighted a potential link between androgen suppression therapy (AST) and bladder cancer (BCa). However, there is a notable gap in research specifically examining the influence of finasteride on BCa risk and clinical outcomes. This study aimed to evaluate preventive and therapeutic value of finasteride for BCa patients.MethodsThis meta-analysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines. The PubMed, Embase, Cochrane Library, and Web of Science databases were searched up to 20 December 2024, to identify studies that examined the intake of finasteride and its impact on the incidence and clinical prognosis of patients with BCa. Data was extracted for further analysis by two different reviewers who independently examined the titles and abstracts of the included articles. Subgroup analyses and leave-one-out sensitivity analyses, were applied to mitigate the potential confounding factors associated with heterogeneity.ResultsOur investigation revealed that finasteride markedly decreased the likelihood of developing BCa (hazard ratio [HR]: 0.75, 95% confidence interval [CI]: 0.63–0.88). Subgroup analyses indicated that the preventive effect of finasteride in BCa incidence were generally consistent, regardless of study region, types of research. Furthermore, no notable disparities were observed in OS, CSS, or RFS between the finasteride group and the control group.ConclusionFinasteride plays a protective role against the progression of BCa, nevertheless, its effects on prognostic outcomes, including OS, CSS, and RFS, remain inconclusive. Additional multi-center prospective studies with long-term follow-up are required to further validate prophylactic role of finasteride on bladder cancer.Systematic review registration numberhttps://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=525046, identifier CRD42024525046.

Incidence and Outcomes of Secondary Bladder Cancer Following Radiation Therapy for Prostate Cancer: A Systematic Review and Meta-analysis.

There is an established association between secondary bladder cancers (SBCs) and radiotherapy (RT) for prostate cancer (PC), which remains a significant concern. Our aim was to update the evidence on SBC incidence across different RT modalities and to compare oncological outcomes for patients diagnosed with SBC to those diagnosed with primary bladder cancer (PBC). We searched MEDLINE, Scopus, and Web of Science for studies on SBC following PC. Pairwise meta-analyses were conducted to compare SBC incidence in terms of odds ratios (ORs) between RT modalities (external beam radiation therapy [EBRT], brachytherapy [BT], and BT + EBRT) and PBC incidence after radical prostatectomy (RP). SBC incidence data are presented as proportions, and pairwise meta-analyses were used to compare overall survival (OS) between SBC and PBC using hazard ratios (HRs). Thirty-one studies (n=576 341) were included. All RT modalities significantly increased the risk of SBC in comparison to RP at all time points investigated. BT alone had similar long-term SBC risk in comparison to EBRT (OR 0.56, 95% confidence interval [CI] 0.25-1.23 at 10yr; OR 0.51, 95% CI 0.24-1.06 at 15yr). There was no significant difference in OS between SBC and PBC in the overall cohort. However, among patients requiring radical cystectomy (RC), SBC resulted in a significant decrease in OS in comparison to PBC (HR 1.55, 95% CI 1.06-2.26; p=0.02). All RT modalities increased the risk of SBC at each post-RT time point investigated. SBC patients requiring RC have worse survival than those with PBC. Our results highlight the need for ongoing surveillance and early detection. Despite the rarity of SBC, clinicians should monitor bladder symptoms in PC patients after RT. These data need to be included in the shared decision-making process with patients regarding therapeutic decisions to raise awareness of SBC in this setting.

New Trends and Future Perspectives in the Diagnosis of Urothelial Carcinoma: A Comprehensive Review of the Literature.

Despite the high incidence of bladder cancer (it represents the 7th most common cancer in males), EAU guidelines do not recommend any technique for screening and prevention, whereas the main diagnostic tools remain computed tomography urography (CTU), cytology, and cystoscopy. Unfortunately, these gold-standard modalities are mainly characterized by low sensitivity and accuracy. To minimize the limitations and increase the detection rates of urothelial cancer, several technologies have been developed. In our review, we summarize all the available data concerning the contemporary technological novelties that include imaging, cytology, and endoscopic techniques in pursuit of finding the optimal combination of diagnostic tools that can provide better detection accuracy.

Rural Versus Urban Genitourinary Cancer Incidence and Mortality in Pennsylvania: 1990-2019.

Our aim was to describe the incidence and mortality of genitourinary (GU) cancers in rural and urban Pennsylvania counties. We calculated age-adjusted incidence and mortality rates of GU (prostate, bladder, and kidney) cancers from 1990 to 2019 in the Pennsylvania Cancer Registry. We defined rurality using the Center for Rural Pennsylvania's population density-based definition. We modeled average annual percent changes (AAPC) in age-adjusted incidence and mortality rates using joinpoint regression. Overall GU cancer incidence decreased in rural and urban counties (AAPC -7.5%, p = 0.04 and AAPC -6.6%, p = 0.02, respectively). Prostate cancer incidence decreased in rural and urban counties by -10.5% (p = 0.02) and -9.1% (p = 0.01), respectively. Kidney cancer incidence increased in both rural and urban counties, respectively (AAPC = +11.2, p = 0.002 and +9.3%, p = 0.01). GU cancer mortality decreased in rural and urban counties (AAPC = -11.6, p = 0.047 and AAPC -12.2, p = 0.01, respectively). Prostate cancer mortality decreased at similar rates in rural and urban counties (AAPC -15.5, p = 0.03 and -15.4, p = 0.02, respectively). Kidney cancer mortality decreased in urban (AAPC -6.9% p = 0.03) but remained stable in rural counties. Bladder cancer incidence and mortality were unchanged in both types of counties. Over three decades, GU cancer incidence and mortality decreased across Pennsylvania counties.

Risk and survival outcomes of secondary pelvic neoplasm after radiotherapy in female patients with genital neoplasms: A large Population-Based cohort study

Background and purposeTo investigate the impact of radiotherapy (RT) on the risk of secondary pelvic neoplasms (SPN) and the survival outcomes of patients following a diagnosis of female patients with genital neoplasm(FGN). Materials and MethodsUtilizing SEER databases, this study involved 102,895 patients from nine oncology centers, spanning 1990 to 2015. We employed the Fine-Gray competing risks regression methodology to chart the trajectory of SPN development and used the Kaplan–Meier method to calculate the 10-year overall survival rates. ResultsThis study included 25,774 patients in the RT group and 77,121 in the non-radiotherapy (NRT) group. The cumulative incidence rate of SPN was 5.10 % in the RT group and 3.42 % in the NRT group. The RT group showed a significantly higher incidence of bladder cancer (adjusted hazard ratio [HR]: 1.75; 95 % confidence interval [CI]: 1.43–2.14; P < 0.05), colon cancer (adjusted HR: 1.32; 95 % CI: 1.16–1.49; P < 0.05), and rectal cancer (adjusted HR: 1.34; 95 % CI: 1.10–1.65; P < 0.05) compared to the NRT group. After propensity score matching, patients in the RT group who developed bladder cancer had significantly reduced 10-year survival rates compared to patients with primary pelvic tumors (P = 0.01). ConclusionRT is identified as an independent risk factor for the development of SPN in patients with FGN. Patients with FGN who undergo RT demonstrate a significant increase in the risk of developing secondary neoplasms, specifically bladder cancers, and experience a reduction in 10-year survival rates.

Achieving health equity in bladder cancer care: Addressing disparities through collaborative research and evidence-based strategies

The United States has seen a decrease in the incidence of bladder cancer and a decline in mortality rates over the past 20 years. However, not all groups have benefited equally from this trend. The American Association of Community Cancer Centers (ACCC) has issued ten strategies to improve cancer care delivery for underserved patient populations. Unfortunately, the evidence supporting the best methods for reducing disparities in different patient groups and care delivery settings remains severely limited. In this short communication, using a personalized narrative woven into a clinical case, we highlight the need for more research on bladder cancer care delivery to ensure that significant investments in precision oncology translate into genuine improvements for all patients diagnosed with bladder cancer.

Increased tobacco taxation associated with decreased consumption and bladder cancer incidence.

The temporal relationship between smoking exposure and bladder cancer (BC) diagnosis remains ill-defined. This study aims to cross-correlate and temporally associate changes in United States (US) tobacco tax and consumption with BC incidence. US tobacco consumption, tobacco tax data, and BC incidence rates from 1975-2019 were retrieved. A cross-correlation lag time for tobacco tax and consumption on BC incidence was calculated while controlling for national health expenditure. Proxied lag weighted semi-log linear models to determine the rate of change in BC incidence rates associated with a 1% change in tobacco tax percentages on a national and state level. A 1% increase in tobacco tax was associated with a 1.77% decrease in BC incidence over a 6-year period (R2=0.9687, p=0.00044). 22 states had a statistically significant decline in BC incidences correlated with increasing tobacco taxation. Reduction in BC incidence >0.5% were observed in states along the Western and Eastern US borders. Montana, Utah, Nebraska, Arkansas, and Tennessee did not have decreasing BC incidences from tobacco tax increases. California had the most drastic decline in BC incidence (1.98%). Nationally, tobacco consumption decrease in 1 pack per capita was associated with a 0.47% decrease in BC incidence over a 28-year period (R2=0.984, p=0.00011). Declining US tobacco consumption may indicate significant reduction in BC incidence through 2047. Primary prevention through adaptation of state-legislated tax changes may contribute to a reduction in BC incidence in states lying within the Central US. A national tobacco tax initative can be considered given the improvement in population health.

Association between leisure-time physical activity and incident cancer risk: a nationwide population-based cohort study

BackgroundThe effects of physical activity on the development of different types of cancers have not been comprehensively studied. This nationwide, population-based cohort study investigated the effects of leisure-time physical activity (LTPA) on the development of different types of cancer in Taiwanese adults. A total of 67,890 adult participants (≥ 18 y old) from five rounds (2001, 2005, 2009, 2013, and 2017) of the Taiwan National Health Interview Survey were included. LTPA was measured as the metabolic equivalent of task (MET) expenditure per week and was classified as inactive (< 1 MET-h), low (1-7.49 MET-h), or high (≥ 7.5 MET-h). The LTPA and other covariates were collected through in-person interviews at baseline. New-onset cancer was ascertained from histopathological reports. The Fine-Gray sub-distribution method, with death as a competing risk, was used to determine the impact of LTPA on incident cancer risk.ResultsDuring the 844,337 person-years of follow-up, 4,435 individuals developed cancer. Compared to inactive adults, individuals engaging in high levels of LTPA (≥ 7.5 MET-h/week) were significantly associated with a reduced risk of developing cancer (adjusted hazard ratio [aHR] = 0.93; 95% confidence interval [CI] = 0.87–0.99). However, those with low levels of LTPA (1-7.49 MET-h/week) did not exhibit a significant association with a reduced risk of developing cancer (aHR = 1.00; 95% CI = 0.92–1.10). When considering specific types of cancers, participants with high levels of LTPA (≥ 7.5 MET-h/week) had a significantly lower risk of developing bladder cancer (aHR = 0.68; 95% CI = 0.47–0.99), cervical cancer (aHR = 0.48; 95% CI = 0.24–0.95), and thyroid cancer (aHR = 0.64; 95% CI = 0.44–0.93).ConclusionsOur findings suggest that high LTPA (≥ 7.5 MET-h/week) is significantly associated with a low risk of incident bladder, cervical, and thyroid cancers.

Incidence trends, histological subtypes, and topographical distribution of bladder cancer in Iran: a study based on the Iranian National Cancer Registry during 2006-2015.

Bladder cancer (BCa) is a significant public health concern. This study aimed to analyze the incidence trends, histological subtypes, and topographical distribution of BCa in Iran over a decade. This retrospective registry-based study analyzed data on BCa patients diagnosed between March 20, 2006, and March 20, 2015. Following data quality control, age-standardized incidence rates (ASIRs) were calculated for BCa overall, by sex and histological subtype using the new World Health Organization (WHO) standard population. We identified 51,379 BCa cases (81.97% male) with a mean age of 65.10 ± 14.89 years. The overall ASIR was 8.92 per 100,000 (95% CI: 8.84-9.00). While a modest increase in ASIR was observed overall (8.77 in 2006 to 9.64 in 2015) and among males (14.13 in 2006 to 15.95 in 2015) during the study period, males consistently had a significantly higher ASIR compared to females (approximately 4.5:1 ratio). BCa incidence showed a progressive increase across older age groups, particularly those aged 40-44 to 80-84 years. Urothelial cell carcinoma (UCC) was the most prevalent histological type (ASIR: 8.19 to 7.93), followed by adenocarcinoma (AC; ASIR: 0.13 to 0.11). Squamous cell carcinoma (SCC) displayed a decreasing trend (ASIR: 0.11 to 0.06). Both UCC and AC were more frequent in males (approximately 5 and 3 times higher than females, respectively). Malignant neoplasm of the bladder, unspecified, constituted over 95% of BCa topography classifications. This study identified a modest rise in BCa incidence, with male predominance and a higher burden in older adults. Further investigation into potential risk factors contributing to this increase is warranted.

RpoS activates formation of Salmonella Typhi biofilms and drives persistence in the gall bladder.

The development of strategies for targeting the asymptomatic carriage of Salmonella Typhi in chronic typhoid patients has suffered owing to our basic lack of understanding of the molecular mechanisms that enable the formation of S. Typhi biofilms. Traditionally, studies have relied on cholesterol-attached biofilms formed by a closely related serovar, Typhimurium, to mimic multicellular Typhi communities formed on human gallstones. In long-term infections, S. Typhi adopts the biofilm lifestyle to persist in vivo and survive in the carrier state, ultimately leading to the spread of infections via the fecal-oral route of transmission. In the present work, we studied S. Typhi biofilms directly, applied targeted as well as genome-wide genetic approaches to uncover unique biofilm components that do not conform to the CsgD-dependent pathway established in S. Typhimurium. We undertook a genome-wide Tn5 mutation screen in H58, a clinically relevant multidrug resistance strain of S. Typhi, in gallstone-mimicking conditions. We generated New Generation Sequencing libraries based on the ClickSeq technology to identify the key regulators, IraP and RpoS, and the matrix components Sth fimbriae, Vi capsule and lipopolysaccharide. We discovered that the starvation sigma factor, RpoS, was required for the transcriptional activation of matrix-encoding genes in vitro, and for S. Typhi colonization in persistent infections in vivo, using a heterologous fish larval model. An rpoS null mutant failed to colonize the gall bladder in chronic zebrafish infections. Overall, our work uncovered a novel RpoS-driven, CsgD-independent paradigm for the formation of cholesterol-attached Typhi biofilms, and emphasized the role(s) of stress signaling pathways for adaptation in chronic infections. Our identification of the biofilm regulators in S. Typhi paves the way for the development of drugs against typhoid carriage, which will ultimately control the increased incidence of gall bladder cancer in typhoid carriers.

Bladder cancer incidence and mortality among men with and without castration therapy for prostate cancer - a nation-wide cohort study.

Bladder cancer (BC) is a common malignancy in the Western World with men being diagnosed almost four times as often as women. The etiology of bladder cancer may involve sex hormones. Prostate cancer (PCa) patients treated with chemical castration, such as androgen deprivation therapy, or surgical castration, may therefore have a lower risk of developing bladder cancer. In a nation-wide population-based cohort study using national Danish registry data, we included a cohort of men with a first-time PCa diagnosis between 2002 and 2018 divided according to antihormonal treatment in the first year after PCa diagnosis and a comparison cohort consisting of 10 age-matched persons for each PCa patient. Each individual was followed from 1 year after PCa diagnosis until death or end of follow-up. We computed cumulative incidences (risk) and hazard ratios (HRs) for BC. In a second cohort analysis, we determined overall survival and BC-specific mortality, determined from date of BC diagnosis until death. We included 48,776 PCa patients of whom 13,592 were treated with chemical castration, 2,261 with surgical castration, and 32,923 received no antihormonal treatment. The 5-year risk of BC for each PCa group was 1.1%, 0.7%, and 1.3%, respectively, corresponding to an adjusted HR of 1.13 (95% CI 0.98; 1.31), 0.95 (95% CI 0.62; 1.47), and 1.18 (95% CI 1.09; 1.28) compared to individuals without PCa. Patients receiving antihormonal treatment had a slightly lower incidence of BC compared to individuals without PCa, however, this was not supported by the HRs. The treatment, however, was not associated with overall survival.

Supporting the investigation of health outcomes due to airborne emission by different approaches: current evidence for the waste incineration sector

Life cycle assessment (LCA) along with a survey on epidemiologic and oxidative potential studies was used for analysing the current evidence of the impact of airborne emissions from municipal solid waste incineration (MSWI) on human health. The correspondence among investigated health outcomes and pollutants was discussed based on the Chemical Service (CAS) and the International Agency for Research on Cancer (IARC). LCA indicated the ability of MSWI in avoiding human health impact, about − 2 × 10−4 DALY/tonne together with avoided emissions of particulate matter (PM) and resource depletion, about − 2.5 × 10−3 kg Sbeq/tonne and about − 0.11 kg PM2.5 eq/tonne, respectively. Positive emissions were detected for greenhouses (about 900 kg CO2eq/tonne) and ecotoxicity (about 15,000 CTUe/tonne). Epidemiologic studies performed on population exposed to MSWI reported quite contrasting results. In some of these, hazard ratio (HR) ranging from about 0.7 to 2.2 was reported concerning the incidence of stomach, liver, breast and bladder cancer. Larger agreement was detected concerning the incidence of larynx and lung cancer with HR ranging from about 1 to about 2.6. Direct causal nexuses were not definitively identified. Oxidative potential of PM was characterized by a high Pearson correlation > 0.8 to the presence of CrVI, Cu and Zn. These heavy metals were also identified by both CAS and IARC as toxic (i.e. Cu and Zn) and cancerous (i.e. CrVI) substances affecting the organs of both respiratory and digestive apparatus. In general, even if more research is necessary, LCA, oxidative potential and the epidemiologic survey results showed a high level of accordance. This suggests their integrated exploitation for supporting the investigation of both direct and indirect consequences on environment and health related to waste incineration for both retrospective and predictive studies.

Health risk assessment of heavy metals in groundwater sources: carcinogenic and non-carcinogenic evaluation

ABSTRACT Persistent exposure to arsenic, chromium, cadmium, lead, and selenium in drinking water above permissible levels poses significant health risks, including increased incidences of skin, lung, bladder, and kidney cancers. This study evaluated 34 water samples from Rupnagar district, Punjab, for heavy metal content. Health risks were assessed using hazard quotient (HQ) and chronic daily intake metrics. Aluminium concentrations were highest in Block Nurpur Bedi (36.43 mg/L). Arsenic levels in Ropar and Anandpur Sahib were 0.09 and 0.068 mg/L, respectively. Cadmium was highest in Nurpur Bedi (0.041 mg/L). Morinda had the highest selenium concentration (0.0038 mg/L). Lead was detected across all blocks, peaking in Chamkaur Sahib (2.176 mg/L). The HQ exceeded unity in nearly all areas, indicating significant health risks from aluminium, arsenic, and lead. The hazard index was highest in Nurpur Bedi (2.66) for adults. Incremental Life Cancer Risk (ILCR) values indicated a high cancer risk from arsenic, chromium, and lead across all blocks. One-way analysis of variance revealed significant differences among Fe, As, and Al concentrations (p &amp;lt; 0.05). The findings underscore the need for targeted treatment technologies and policies to mitigate heavy metal contamination and its health impacts in Punjab.

Are androgen receptor agonists a treatment option in bladder cancer?

Sex-related differences in bladder cancer incidence and progression infer a role for sex hormones and their cognate receptors in this disease. In part due to the oncogenic role of androgen receptor signaling in prostate cancer, the focus of most preclinical and clinical research to-date has been on the potential pro-tumorigenic action of androgens in urothelial cancers. However, clinical studies of androgen receptor antagonism have yielded minimal success. In this review, we explore the tumor suppressor role of androgen receptor in bladder cancer and discuss how it might be harnessed therapeutically.

The disease burden of bladder cancer and its attributable risk factors in five Eastern Asian countries, 1990–2019: a population-based comparative study

BackgroundsThe study aimed to estimate bladder cancer burden and its attributable risk factors in China, Japan, South Korea, North Korea and Mongolia from 1990 to 2019, to discuss the potential causes of the disparities.MethodsData were obtained from the Global Burden of Disease Study 2019. The annual percent change (APC) and average annual percent change (AAPC) were calculated by Joinpoint analysis, and the independent age, period and cohort effects were estimated by age-period-cohort analysis.ResultsIn 2019, the highest incidence (7.70 per 100,000) and prevalence (51.09 per 100,000) rates of bladder cancer were in Japan, while the highest mortality (2.31 per 100,000) and DALY rates (41.88 per 100,000) were in South Korea and China, respectively. From 1990 to 2019, the age-standardized incidence and prevalence rates increased in China, Japan and South Korea (AAPC > 0) and decreased in Mongolia (AAPC < 0), while mortality and DALY rates decreased in all five countries (AAPC < 0). Age effects showed increasing trends for incidence, mortality and DALY rates, while the prevalence rates increased first and then decreased in older groups. The cohort effects showed downward trends from 1914–1918 to 2004–2008. Smoking was the greatest contributor and males had the higher burden than females.ConclusionBladder cancer was still a major public health problem in East Asia. Male and older population suffered from higher risk, and smoking played an important role. It is recommended that more efficient preventions and interventions should be operated among high-risk populations, thereby reduce bladder cancer burden in East Asia.

Varying the intensity of cystoscopic surveillance for high-risk non-muscle-invasive bladder cancer.

To compare the clinical, economic, and health utility outcomes associated with alternative cystoscopic surveillance regimens for high-risk non-muscle-invasive bladder cancer (HRNMIBC). We performed real-world clinical data-driven microsimulations of a hypothetical cohort of 100 000 patients diagnosed with HRNMIBC at age 70 years. The cohort was simulated to undergo alternative surveillance regimens recommended by five guidelines, and two hypothetical regimens-surveillance intensity escalation and de-escalation-which had a surveillance intensity moderately higher and lower, respectively, than the guideline-recommended regimens. We evaluated the 10-year cumulative incidence of muscle-invasive bladder cancer (MIBC), cancer-specific survival (CSS), overall survival (OS), and cost-effectiveness from a United States healthcare payer perspective. The guideline-recommended surveillance regimens led to an estimated 10-year cumulative incidence of MIBC ranging from 11.0% to 11.6%, CSS 95.0% to 95.2%, and OS 69.7% to 69.8%. Surveillance intensity escalation resulted in a 10-year cumulative incidence of MIBC of 10.5% (95% confidence interval [CI] 10.3-10.7%), CSS of 95.4% (95% CI 95.2-95.5%), and OS of 69.9% (95% CI 69.6-70.1%), vs 11.9% (95% CI 11.7-12.1%), 94.9% (95% CI 94.8-95.1%), and 69.6% (95% CI 69.3-69.9%), respectively, from surveillance intensity de-escalation. By increasing surveillance intensity, the number-needed-to-treat to prevent one additional MIBC progression over 10 years was ≥80, and ≥257 to avoid one additional cancer-related mortality. Compared to surveillance intensity de-escalation, higher-intensity regimens incurred an incremental cost of ≥$336 000 per incremental quality-adjusted life year gained, which well exceeded conventional willingness-to-pay thresholds, ≥$686 000 per additional MIBC progression prevented, and ≥$2.2 million per additional cancer-related mortality avoided. In microsimulations testing a wide range of cystoscopic surveillance intensity for patients newly diagnosed with HRNMIBC, moderate surveillance de-escalation appears associated with an insignificant change in 10-year OS and furthermore is cost-effective vs higher-intensity surveillance regimens. These results suggest that moderate surveillance de-escalation can reduce costs of care without compromising life expectancy for many patients.

Economic Impact of Bladder Cancer in the USA.

Incidence and mortality for bladder cancer has changed very little over the past 20 years. Approximately 40% of patients with high-risk nonmuscle invasive bladder cancer eventually recur/progress. It is important to understand the economic impact of disease recurrence/progression in bladder cancer. Our aim was to estimate and understand the direct costs associated with the treatment of bladder cancer from the payer's perspective in the USA, in the year of 2021, including costs for both newly diagnosed bladder cancer (stages 0a-IV) and recurrent patients. An economic model was constructed to calculate the number of patients receiving each treatment modality at every stage of disease and their respective costs. Epidemiological data were based on the CancerMPact Patient Metrics (PM) database and treatment modality data retrieved from CMP Treatment Architecture (TA), 2021 version. Resource utilization and costs were obtained from medical literature and public data sources. Only direct costs were considered. There were an estimated 83,532 newly diagnosed patients with bladder cancer of all stages in 2021 with a projected total cost of treatment of ~$2.6 billion. Average cost per newly diagnosed patient varied from $19,521 (stage 0a) to $169,533 (metastatic disease). Cost profile differed substantially among the stages of disease. For the 75,760 patients that were expected to have a recurrence in 2021, an additional cost of ~$3.9 billion was estimated at an average cost per patient of $52,179. The expected total cost to treat newly diagnosed and newly recurrent patients is reported in this model, with the total cost in 2021 estimated to exceed $6.5 billion. Treatment and resource costs increase for bladder cancer as the disease recurs/progresses. More effective treatments that can delay recurrence/progression may reduce the economic burden associated with bladder cancer.

Association between long-term exposure to mixture of ambient air pollutants and bladder cancer incidence

Association between long-term exposure to mixture of ambient air pollutants and bladder cancer incidence

Molecular biomarkers of progression in non-muscle-invasive bladder cancer - beyond conventional risk stratification.

The global incidence of bladder cancer is more than half a million diagnoses each year. Bladder cancer can be categorized into non-muscle-invasive bladder cancer (NMIBC), which accounts for ~75% of diagnoses, and muscle-invasive bladder cancer(MIBC). Up to 45% of patients with NMIBC develop disease progression to MIBC, which is associated with a poor outcome, highlighting a clinical need to identify these patients. Current risk stratification has a prognostic value, but relies solely on clinicopathological parameters that might not fully capture the complexity of disease progression. Molecular research has led to identification of multiple crucial players involved in NMIBC progression. Identified biomarkers of progression are related to cell cycle, MAPK pathways, apoptosis, tumour microenvironment, chromatin stability and DNA-damage response. However, none of these biomarkers has been prospectively validated. Reported gene signatures of progression do not improve NMIBC risk stratification. Molecular subtypes of NMIBC have improved our understanding of NMIBC progression, but these subtypes are currently unsuitable for clinical implementation owing to a lack of prospective validation, limited predictive value as a result of intratumour subtype heterogeneity, technical challenges, costs and turnaround time. Future stepsinclude thedevelopment of consensus molecular NMIBC subtypes that mightimprove conventional clinicopathological risk stratification. Prospective implementation studies of biomarkers and the design ofbiomarker-guided clinical trials are required for the integration of molecular biomarkersinto clinical practice.

Incidence, initial management and survival of high-risk non-muscle invasive bladder cancer in Northern France

ObjectiveInformation on bladder cancer (BC) according to the risk scoring for recurrence or progression in a general population is scarce despite its clinical relevance. The objective was to describe the characteristics of incident BC in a general population, with a focus on the initial management of high-risk non-muscle invasive BC (HR-NMIBC). MaterialsBC incident in 2011–2012 recorded in a population-based cancer registry were studied. Data was extracted from medical files. NMIBC were classified according to potential risk for recurrence/progression. Individual and tumor characteristics of incident BC were described. Incidence, initial management and survival (12/31/2021) of HR-NMIBC were assessed. ResultsAmong 538 BC cases, 380 were NMIBC [119 low (22.1%), 163 intermediate (30.3%), 98 high (18.2%) risk] and 147 (27.3%) were MIBC. HR-NMIBC diagnostic and therapeutic management [imaging, re-TUR, multidisciplinary team meetings (MDT) assessment, specific treatment] revealed discrepancies with guidelines recommendations. Seventy-two out of 98 cases were assessed in an MDT with a median time from diagnosis of 18days [first quartile: 12-third quartile: 32]. Globally, treatment agreed with MDT decisions. Intravesical instillation was the most common treatment (n=56) but 27 HR-NMIBC did not receive specific treatment after TUR. Five and 10years overall survival was 52% [42–63] and 41% [31–51], respectively. Five years net survival was 63% [47–75]. ConclusionsDespite National cancer plans aiming to improve care giving and despite the severity of HR-NMIBC, guideline-recommended patterns of care were underused in this region. This may deserve attention to identify obstacles to guideline adoption to try to improve BC patient care and survival. Level of evidence3