Natural History Of Bladder Cancer Research Articles

Estimating the Prevalence of Bladder Cancer by Stage in Iran as a Developing Country.

Background: Bladder cancer is among the 10 most common cancers globally and in Iran. The prevalence rate is a crucial metric for both estimating disease burden and policymakers. On the other hand, bladder cancer is a heterogeneous disease with different stages, high recurrence, and progression rate. In planning treatment procedures, it is important to know the prevalence of bladder cancer by stages. In the current study, we aimed to estimate the 5-year prevalence of bladder cancer by stages using the Markov model. Methods: This was a simulation study. To estimate the 5-year prevalence of bladder cancer by stages, we used the Markov model with a time horizon of 5 years following diagnosis. We simulated the natural history of bladder cancer using a literature review. We extracted survival rate, stage-specific recurrence, and progression rate using local and international publications and expert opinion. In addition, we used the Iranian life table and extracted probabilities of mortality due to other causes of death. Results: Five-year prevalence of bladder cancer for the year 2018 was estimated at 21,807 patients. Non- muscle-invasive bladder cancer accounted for around 68% of all cases, with 42% in the Ta low-grade stage. About 32% of bladder cancer prevalent cases were muscle-invasive bladder cancer patients, from which about 8% had metastatic tumors. Conclusion: Researchers and policymakers can utilize the findings of this study to conduct economic burden analyses and plan resource allocation.

Clinical behavior and survival outcome of urothelial bladder cancer in young adults.

Background:Bladder cancer (BC) is rare in young adults and therefore natural history of BC is still debatable. This study aimed to determine clinical behavior and prognosis of BC in patients <40 years.Materials and Methods:We reviewed patients (<40 years) managed with urothelial BC from 2003 to 2019. Patients with nonurothelial histology were excluded. Clinical behavior and prognosis such as recurrence, progression, and survival were assessed. The recurrence is defined as a newly diagnosed occurrence of BC at previous or new site(s). Cancer progression is defined as an increase in staging or grade.Results:Fifty-five patients inclusive of 45 males and 10 females with a median age of 30.0 (interquartile range [IQR] 25.0–33.0) years were included. The median follow-up was 3.5 (IQR: 1.5–7.0) years. Fifty-one (92.72%) patients were diagnosed with nonmuscle-invasive BC while four (7.27%) patients were diagnosed with muscle-invasive disease. Three out of four patients with muscle-invasive BC died of metastatic disease. According to stage and grade, there were 42 (76.36%) Ta, 9 (16.36%) T1 and 4 (7.27%) having T2 stage while 41 (74.54%) low grade and 14 (25.45%) were having high grade disease. Thirty-six (65.45%) patients remained stable, 13 (26.63%) patients progressed, and 6 (10.90%) patients regressed to lower stage and grade. Higher stage and grade (P = 0.0431) and tumor size >3 cm (P = 0.0454) were significant for recurrence, and higher stage and grade (P = 0.0012) and tumor size >3 cm (P = 0.0055) were associated with tumor progression.Conclusion:BC in younger adults is mostly low stage and low grade. We should be vigilant in patients with higher stage and grade as it is related with recurrence, progression, and metastatic disease.

Immunotherapy for Patients with Advanced Urothelial Cancer: Current Evidence and Future Perspectives.

In recent years, immunotherapy has produced encouraging results in a rapidly increasing number of solid tumors. The responsiveness of bladder cancer to immunotherapy was first established in nonmuscle invasive disease in 1976 with intravesical instillations of bacillus Calmette-Guérin (BCG). Very recently immune checkpoint inhibitors demonstrated good activity and significant efficacy in metastatic disease. In particular the best results were obtained with programmed death-ligand-1 (PD-L1) and programmed death-1 (PD-1) inhibitors, but many other immune checkpoint inhibitors, including anti-cytotoxic T-lymphocyte-associated protein-4 (CTLA-4) antibodies, are currently under investigation in several trials. Simultaneously other therapeutic strategies which recruit an adaptive immune response against tumoral antigens or employ externally manipulated tumor infiltrating lymphocytes might change the natural history of bladder cancer in the near future. This review describes the rationale for the use of immunotherapy in bladder cancer and discusses recent and ongoing clinical trials with checkpoint inhibitors and other novel immunotherapy agents.

Urothelial carcinoma of the bladder: definition, treatment and future efforts

The identification of patients with high-risk bladder cancer is important for the timely and appropriate treatment of this lethal disease. The understanding of the natural history of bladder cancer has improved; however, the criteria used to define high-risk disease and the relevant treatment strategies have remained the same for the past several decades, despite multiple large, randomized, prospective clinical trials that have evaluated the use of intravesical, surgical and systemic therapies. The genetic signature of high-risk bladder cancer has been a focus of investigation and has led to the discovery of potential molecular targets for disease identification, risk stratification and therapy. These advances, combined with a comprehensive risk assessment profile that incorporates available pathological and clinical characteristics, might improve the diagnosis and treatment of patients with bladder cancer.

15- CARCINOMA OF THE URINARY BLADDER: AGE DIFFERENCES.

15- CARCINOMA OF THE URINARY BLADDER: AGE DIFFERENCES.

1026 WHAT DO MOST PATIENTS WITH BLADDER CANCER ULTIMATELY SUCCOMB TO: A 25-YEAR FOLLOW-UP OF A SINGLE INSTITUTION'S BLADDER CANCER REGISTRY (1980-2004)

You have accessJournal of UrologyBladder Cancer: Staging1 Apr 20101026 WHAT DO MOST PATIENTS WITH BLADDER CANCER ULTIMATELY SUCCOMB TO: A 25-YEAR FOLLOW-UP OF A SINGLE INSTITUTION'S BLADDER CANCER REGISTRY (1980-2004) Alan Nieder and Anna Ruiz Alan NiederAlan Nieder More articles by this author and Anna RuizAnna Ruiz More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.2061AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES A large percentage of bladder cancer (BC) cases are related to tobacco use, which is also a risk factor for cardiopulmonary disease. We have previously demonstrated that there have been no significant improvements in patients presenting with advanced disease over the last 25 years. We now sought to evaluate if there have been any significant trends in cause of death over this time period in our patient population which includes a high percentage of Hispanics. METHODS Our single institution's tumor registry was retrospectively evaluated for all cases of BC since the registry's inception (1980). All cases were evaluated and analyzed by stage, age, sex and ethnicity at diagnosis. 5- and 10-year survival data was analyzed. We specifically analyzed cause of death (including secondary malignancies). RESULTS Between 1980 and 2004, we identified 1436 cases of BC. 74% of patients were male and 26% were female. White, Black and Hispanics comprised 81%, 2%, and 14%, respectively. In the most recent decade, Hispanics comprised 23% of our cohort. Most patients were diagnosed with non-invasive vs. muscle-invasive disease: 81% and 19% respectively. Non-contemporary patients had worse survival. 5-year overall survival in patients diagnosed in the 1980s, 1990s, and 2000s were: 46%, 54% and 55%, respectively. 10-year overall survival for those diagnosed in the 1980s and 1990s were 23.9% and 29.5%, respectively. Of the 1055 of patients who expired during the study period (73%), the cause of death was BC, cardiopulmonary disease, and secondary malignancy in 22%, 36% and 8%, respectively. Of our cohort, over 50% were identified as tobacco users (including 21% who were current smokers at the time of their diagnosis.) CONCLUSIONS Over a 25-year period, we identified 1436 patients with BC, of whom 73% expired during follow-up. A far greater percentage of patients expired from cardiopulmonary disease or a secondary malignancy, as opposed to BC. Tobacco usage likely plays a large etiologic role in the development of BC and other malignancies, as well as cardiopulmonary disease. Future investigations should be initiated to evaluate the specific benefits of tobacco cessation as it relates to BC and cardiopulmonary disease in this specific patient population. Furthermore, patients need to be made aware of the likely natural history of BC in relationship with—and taking into account—their comorbidities, which for most patients will have a far greater impact on their future morbidity and mortality, than their low-grade non-invasive bladder cancer may. Miami Beach, FL© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e399 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alan Nieder More articles by this author Anna Ruiz More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Carcinomatous meningitis in a patient with Her2/neu expressing bladder cancer following trastuzumab and chemotherapy: a case report and review of the literature

IntroductionTargeted therapies may impact the natural history of bladder cancer based upon their pharmacokinetics. The Her2/neu receptor tyrosine kinase, overexpressed by half of all primary urothelial carcinomas, has recently been examined as a therapeutic target in bladder cancer in a prospective phase II multicenter trial (NCI-198) that enrolled 109 patients with advanced bladder carcinomas for treatment with trastuzumab in combination with paclitaxel, carboplatin, and gemcitabine. We report on documented isolated Her2/neu positive carcinomatous meningitis in a patient treated with trastuzumab.Case presentationA 61-year-old Caucasian man with metastatic bladder cancer was treated with neoadjuvant chemotherapy in combination with trastuzumab with a partial response that was followed by a complete response after surgery. He relapsed with isolated Her2/neu positive carcinomatous meningitis.ConclusionCarcinomatous meningitis in bladder cancer is extremely rare. This is the first case reported of Her2/neu positive carcinomatous meningitis. Disease recurred solely at a sanctuary site, demonstrating that despite the systemic efficacy of trastuzumab in combination with chemotherapy, its inability to enter the central nervous system potentially contributes to the unusual site of disease recurrence.

Bladder Cancer Risk Following Primary and Adjuvant External Beam Radiation for Prostate Cancer

Purpose Increased rates of secondary bladder malignancies have been reported after external beam radiation therapy (EBRT) for gynecological malignancies with relative risks of 2 to 4. This study was designed to determine if there was an increase in bladder cancer after EBRT for prostate cancer. Materials and Methods We retrospectively reviewed the Mayo Clinic Cancer Registry for patients who received EBRT for prostate cancer (1980 to 1998). Patients diagnosed with bladder cancer were identified. Comparative incidence rates were obtained from the national Surveillance, Epidemiology and End Results database. Subset analysis included patients treated with adjuvant radiation and those residing locally. Medical histories of patients with bladder cancer were reviewed. Results A total of 1,743 patients received EBRT for prostate cancer at our institution. In more than 12,353 man-years of followup no increase in bladder cancer risk was encountered. Subset analysis of men who received adjuvant radiation demonstrated that the relative risk of bladder cancer was increased but was not statistically significant. When the analysis was restricted to patients residing in the local area, the number of patients in whom subsequent bladder cancer developed was similar to Surveillance, Epidemiology and End Results rates. However, in the adjuvant radiation subset there was a statistically significant increase in subsequent bladder cancer. Patients in whom bladder cancer develops after EBRT often present with low grade disease but many have recurrence and progression. Conclusions This retrospective review suggests there is not evidence of increased risk of bladder cancer after radiation therapy, assuming unbiased followup and complete ascertainment of cases. The natural history of bladder cancer in this population does not seem to be altered by a history of radiation.

Radical Cystectomy and Lymphadenectomy for Invasive Bladder Cancer: Towards the Evolution of an Optimal Surgical Standard

The surgical management of invasive bladder cancer has undergone a significant evolution in technique since its initial introduction. Changes in the extent of surgery have largely reflected a better understanding of the natural history of bladder cancer and the recognized pathways of progression. Incorporation of contemporary surgical techniques that target the perivesical soft tissues, regional lymph nodes, and adjacent organs appear to enhance oncologic outcomes. A growing body of evidence indicates that the quality of radical cystectomy (RC) directly affects patient outcome. Recently, quality of life and functional considerations have led to surgical modifications such as nerve-, prostate-, vaginal wall-, and urethra-sparing approaches. While some modifications in appropriate candidates appear not to decrease cancer control, further studies will be needed to establish their role and safety. This ongoing evolution in the technique of RC and pelvic lymph node dissection (PLND) may help define a new surgical standard that provides optimal benefit in patients with invasive bladder cancer.

Superficial bladder cancer: part 1. Update on etiology, classification and natural history

Superficial ‘nonmuscle-invasive’ bladder tumors represent a heterogeneous group of cancers, which include those that are papillary in nature and limited to the mucosa (Ta), high grade, flat and confined to the epithelium (Tis) and those that invade the submucosa or lamina propria (T1). The natural history of these bladder cancers is that of disease recurrence and progression to higher grade and stage. Furthermore, recurrence and progression rates of superficial bladder cancer vary according to several tumor characteristics. The goal in the treatment of superficial bladder cancer is twofold: reducing tumor recurrence and the subsequent need for additional therapies, such as cystoscopy, transurethral resections, intravesical therapy and the morbidity associated with these treatments; and preventing tumor progression and the subsequent need for more aggressive therapy, such as radical cystectomy. The administration of intravesical chemotherapy and immunotherapy has become an important component in accomplishing these goals. This update is the first part of two articles reviewing important contemporary concepts in the etiology, classification and natural history of superficial bladder cancer, while part II of the series will review and highlight important aspects in management of superficial bladder cancer.

1233: Natural History of Bladder Cancer in Patients with P0 Disease at Radical Cystectomy

1233: Natural History of Bladder Cancer in Patients with P0 Disease at Radical Cystectomy

BLADDER CANCER RISK FOLLOWING PRIMARY AND ADJUVANT EXTERNAL BEAM RADIATION FOR PROSTATE CANCER

Increased rates of secondary bladder malignancies have been reported after external beam radiation therapy (EBRT) for gynecological malignancies with relative risks of 2 to 4. This study was designed to determine if there was an increase in bladder cancer after EBRT for prostate cancer. We retrospectively reviewed the Mayo Clinic Cancer Registry for patients who received EBRT for prostate cancer (1980 to 1998). Patients diagnosed with bladder cancer were identified. Comparative incidence rates were obtained from the national Surveillance, Epidemiology and End Results database. Subset analysis included patients treated with adjuvant radiation and those residing locally. Medical histories of patients with bladder cancer were reviewed. A total of 1,743 patients received EBRT for prostate cancer at our institution. In more than 12,353 man-years of followup no increase in bladder cancer risk was encountered. Subset analysis of men who received adjuvant radiation demonstrated that the relative risk of bladder cancer was increased but was not statistically significant. When the analysis was restricted to patients residing in the local area, the number of patients in whom subsequent bladder cancer developed was similar to Surveillance, Epidemiology and End Results rates. However, in the adjuvant radiation subset there was a statistically significant increase in subsequent bladder cancer. Patients in whom bladder cancer develops after EBRT often present with low grade disease but many have recurrence and progression. This retrospective review suggests there is not evidence of increased risk of bladder cancer after radiation therapy, assuming unbiased followup and complete ascertainment of cases. The natural history of bladder cancer in this population does not seem to be altered by a history of radiation.

Transurethral Resection For Bladder Cancer Using 5-Aminolevulinic Acid Induced Fluorescence Endoscopy Versus White Light Endoscopy

Endoscopy done under fluorescence induced by 5-aminolevulinic acid has proved to be a procedure with high sensitivity for detecting transitional cell carcinoma of the bladder. In this multicenter, parallel group, phase III study we compared 5-aminolevulinic acid fluorescence endoscopy guided transurethral bladder resection with transurethral bladder resection done using only white light endoscopy. The proportion of tumor-free resected cases in the 2 groups was evaluated. After patient stratification according to participating centers and European Organization for the Research and Treatment of Cancer risk score 65 and 64 were randomized to the 5-aminolevulinic acid fluorescence and white light endoscopy groups, respectively. Residual tumor was evaluated in the 2 groups by repeat transurethral resection 10 to 14 days later. Analysis was performed according to the intent to treat principle with all patients randomized, followed by per protocol analysis. Intent to treat analysis revealed that in the white light endoscopy group 40.6% of cases were resected tumor-free at primary resection, whereas with 5-aminolevulinic acid fluorescence endoscopy guided transurethral resection 61.5% were resected tumor-free (p <0014). On protocol analysis 46.9% patients in the white light and 67.3% in the 5-aminolevulinic acid fluorescence endoscopy groups were resected tumor-free (p <0.031). No difference was noted in the 2 groups in regard to side effects or laboratory findings. The risk of residual tumor after transurethral resection of transitional cell carcinoma is significantly decreased by 5-aminolevulinic acid fluorescence endoscopy.

THE NATURAL HISTORY OF BLADDER CANCER: Implications for Therapy

Transitional cell carcinoma of the bladder is comprised of a variety of cancer diatheses that manifest a spectrum of distinct biologic potentials. Although these diseases have traditionally been classified as "superficial" and "muscle invasive" on the basis of their histologic appearance (depth of penetration of the "bladder wall" and corresponding prognosis) the pathways presumably followed by the various forms of these cancers imply an even greater complexity. These disparate pathways may reflect different events in carcinogenesis, which may determine subsequent development and risk for either recurrence or progression. In addition, biologic activity and malignant potential for each type of cancer may be associated with distinctive molecular and genetic alterations. These considerations may provide an opportunity to expand traditional staging systems in creating molecular profiles that may more precisely characterize the biologic potential of these tumor diatheses. Although there are far more questions than answers concerning how these alterations may effect the natural history of bladder cancer, molecular-based identification of bladder cancer patients at greatest risk for progression may ultimately improve clinical management.

Cystectomy and urinary diversion.

New insights into bladder cancer mechanisms have not yet produced clinical benefit. Without novel treatments, cystectomy remains the most effective local treatment, albeit the most aggressive. Uncertainty about the natural history of bladder cancer, the progression rate after other treatments, the risks of cystectomy and subsequent quality of life, foster debate about the indications for cystectomy. There are numerous urinary diversions and bladder substitutes. Differences in tumour extent, patient age, performance status, renal and mental function, and acceptance make different diversion techniques necessary. Urologists need not know every technique, but should know at least one technique of each class: an incontinent diversion (such as the ileal conduit), ureterosigmoidostomy, continent reservoir, and orthotopic bladder substitute. The common principles, advantages, and contraindications of these techniques are discussed.

Detection, diagnosis, and natural history of bladder cancer

Detection, diagnosis, and natural history of bladder cancer

Relationship between blood groups and tumour grade, number, size, stage, recurrence and survival in patients with transitional cell carcinoma of the bladder.

Blood group was correlated with the tumour grade, number, size, stage and recurrence rate and with survival in 261 consecutive patients with bladder cancer analyzed at least five years after diagnosis of the disease. The distribution of blood groups did not differ from that in the general population. There were no significant differences in the incidence of invasion at the time of diagnosis or later, in the number of the tumours or in the recurrence rate. A tendency for high-grade and large-sized tumours was observed in the blood groups O(H) and B. Differences in mortality were not observed until eight years after diagnosis, so that 28% of the patients with blood group A and 40% of those with blood group O had died of bladder cancer by ten years after diagnosis. Since the differences are small, the clinical significance of blood groups as a prognostic factor in bladder cancer patients is minimal. However, there seems to be a need for further research of the significance of genetic background in the natural history of bladder cancer.

Rapid induction of carcinoma in situ in dog urinary bladder by sequential treatment with N-methyl-N'-nitrosourea and N-butyl-N-(4-hydroxybutyl)-nitrosamine.

A highly atypical intraepithelial proliferation, which was interpreted as carcinoma in situ, developed in the urinary bladder of 2 beagle dogs after repeated intravesical instillations of N-methyl-N'-nitrosourea followed by oral administration of N-butyl-N-(4-hydroxybutyl)nitrosamine. The latent period was 37 weeks. The technique may provide a useful model to study the natural history of bladder cancer, particularly carcinoma in situ.

Therapeutic efficacy of salvage cystectomy Do results reflect natural history of bladder cancer?

In a retrospective review of patients who underwent salvage cystectomy, patients with muscle-invasive cancers who had initially presented with tumors that were pathologically T A or T 1 appeared to have a better prognosis than those who had muscle-invasive (T 2 or T 3) cancers on initial clinical presentation. Prognosis in each group appeared to correlate with the stage of tumor at initial clinical presentation rather than with stage of tumor at recurrence after radiation therapy. Prognosis also appeared to correlate with architectural configuration of the presenting tumor as well as the type of invasion. Thus, papillary lesions with muscle invasion by a broad front of histologically cohesive blocks of cells appeared to have a better prognosis than did solid or nodular lesions that appeared to invade the muscle wall in a tentacular fashion with fingerlike tumor cell extensions that seemed to percolate through the bladder wall. Taken together, the results of treatment in these patients may have represented the intrinsic nature of their particular tumors.