Grade T1 Research Articles

Editorial Comment on: Characteristics and Outcomes of Patients with Clinical T1 Grade 3 Urothelial Carcinoma Treated with Radical Cystectomy: Results from an International Cohort

Editorial Comment on: Characteristics and Outcomes of Patients with Clinical T1 Grade 3 Urothelial Carcinoma Treated with Radical Cystectomy: Results from an International Cohort

A combined phase I/II trial of intravesical nanoparticle albumin-bound paclitaxel in the treatment of refractory non–muscle- invasive transitional cell bladder cancer

e16047 Background: Up to 50% of patients treated with intravesical agents for non-muscle-invasive bladder cancer will recur. Response rates to current second line intravesical therapies average less than 20%. For these high risk patients, novel agents are necessary. Our previously completed phase I trial showed docetaxel to be a safe and efficacious agent for intravesical therapy. Nanoparticle albumin-bound (nab-) paclitaxel has been shown to have increased solubility and lower toxicity compared to docetaxel in systemic therapy and is therefore an appropriate candidate for further investigation as an intravesical agent. Methods: The ongoing phase I component of this combined phase I/II trial began enrollment on 1/1/08 and has reached 72% accrual as of 1/1/09. Inclusion criteria include recurrent high grade (HG) Ta, T1 and Tis transitional cell carcinoma failing at least one prior regimen with any intravesical agent. In phase I, 6 weekly instillations of nab-paclitaxel were administered beginning at a dose of 150 mg with a dose escalation model used until a maximal tolerated dose (MTD) was achieved. The primary endpoints were dose- limiting toxicity (DLT) and MTD; the secondary endpoint was response rate. Efficacy was evaluated by cystoscopy with biopsy, cytology, and CT imaging. Results: 13/18 patients have enrolled in this phase I trial to date, and the distribution of stages included 5 patients with Tis, 4 patients with HGTa, and 4 patients with HGT1. No patient has had any systemic absorption of nab-paclitaxel as measured by HPLC assays, and no grade 3 or 4 DLT has been encountered. Fifty-four percent (7/13) patients were noted to experience grade 1 toxicities, with dysuria being the most common. Forty-two percent (5/12) of completed patients had no evidence of disease at their post-treatment cystoscopy. None of the patients who developed recurrent disease have had disease progression. Conclusions: Intravesical nab-paclitaxel has exhibited minimal toxicity and no systemic absorption in the first ever human intravesical dose escalation trial. Upon completion of this ongoing phase I trial, we plan to evaluate this agent in a larger phase II efficacy study. No significant financial relationships to disclose.

Transitional Cell Carcinoma in a Remnant Ureter after Retroperitoneoscopic Simple Nephrectomy for Benign Renal Disease

A 70-yr-old man presented with painless gross hematuria. He underwent right nephrectomy for benign disease 9 yr ago. Computed tomography and cystoscopy showed a mass in the distal region of the right ureteral stump. He underwent right ureterectomy and bladder cuff resection. Pathological examination showed T1 and WHO grade 2 transitional cell carcinoma. At 6 months postoperatively, the patient is alive without any evidence of recurrence.

Retinoblastoma protein expression predicts response to bacillus Calmette-Guérin immunotherapy in patients with T1G3 bladder cancer

Objectives Bacillus Calmette-Guérin (BCG) immunotherapy is regarded as the current treatment of choice for stage T1 grade 3 (T1G3) bladder cancer (BC), though its efficacy is limited by high recurrence and progression rate. Identification of molecular prognosticators that might be helpful in discriminating between responders and nonresponders to BCG treatment is therefore of major clinical importance; thus we focused on the cell-cycle related retinoblastoma protein (pRB), which had been already investigated in bladder cancer. The goal of our study was specifically to address whether its expression predicts the outcomes of BCG treatment for patients with T1G3 disease. Materials and Methods To address this issue, paraffin-embedded specimens of 27 patients having undergone transurethral resection of T1G3 BC and intravesical instillations of BCG (induction + 1 year maintenance) were immunostained with pRB monoclonal antibody. Patients in whom the bladder muscle was not clearly visible, and healthy, as well as patients with TaG3 tumors or with concomitant carcinoma in situ were excluded. Mean follow-up was 60 months (range 15–135). Results Thirteen tumors showed normal (1% to 50% labeling index) while 14 showed altered pRB expression, consisting of no expression (0% labeling index) in six and overexpression (>50% labeling index) in eight. Recurrence occurred in 10 (37%) patients and mean time to recurrence was 22.8 months (range 6–48). Recurrence rate was 57% in patients with altered and 15% in those with normal pRB expression, with a statistically significant difference in disease-free survival ( P = 0.037). Progression occurred in five (18.5%) patients and mean time to progression was 24 months (range 6–48). Progression rate was 36% in patients with altered and 0% in patients with normal pRB expression, with a statistically significant difference in progression-free survival ( P = 0.018). Conclusions In this homogeneous population of T1G3 bladder tumors, altered pRB expression predicted recurrence and progression after BCG treatment. These findings outline the potential role of pRB immunostaining in predicting T1G3 BC response to BCG immunotherapy.

Outcomes of Patients With Clinical T1 Grade 3 Urothelial Cell Bladder Carcinoma Treated With Radical Cystectomy

We read with great interest the report by Gupta et al. on the outcomes of patients with T1G3 urothelial cancer treated with radical cystectomy. 1 Gupta A. Lotan Y. Bastian P.J. et al. Outcomes of patients with clinical T1 grade 3 urothelial cell bladder carcinoma treated with radical cystectomy. Urology. 2008; 71: 302-307 Abstract Full Text Full Text PDF PubMed Scopus (57) Google Scholar We were dismayed to find that the authors incorrectly quoted our recent paper on T1G3 bladder cancer. 2 Masood S. Sriprasad S. Palmer J.H. et al. T1G3 bladder cancer indications for early cystectomy. Int Urol Nephrol. 2004; 36: 41-44 Crossref PubMed Scopus (49) Google Scholar The authors state in the discussion that, “Masood et al., for example, studied 30 patients and found that patients with multiple tumors (with or without concomitant CIS) or a single tumor with concomitant CIS had better survival than patients with a single tumor without CIS.” The conclusion from our study is, in fact, the opposite: patients with single tumors without CIS had the best outcomes in our study. Our results showed clearly that the presence of CIS is a poor prognostic factor, as is tumor multiplicity. We concluded that early radical cystectomy should be offered to patients with single T1G3 and CIS, as well as to those with multiple tumors with or without CIS. The study by Gupta et al. reiterates our conclusion that the presence of CIS is an indication for early cystectomy. Reply by the AuthorsUrologyVol. 72Issue 4PreviewWe agree with Drs. Mufti and Masood. We had incorrectly quoted their paper1 to state that patients with multiple tumors or a single tumor with concomitant CIS have better outcomes. In fact, their results showed the opposite, that patients with a single tumor without CIS have better outcomes than patients with multiple tumors or with a single tumor with concomitant CIS.1 We regret the error. Full-Text PDF

The increasing use of intravesical therapies for stage T1 bladder cancer coincides with decreasing survival after cystectomy: Lambert EH, Pierorazio PM, Olsson CA, Benson MC, McKiernan JM, Poon S, Department of Urology, Columbia University Medical Center, New York, NY.

Objective Intravesical therapy (IVT), chemo, and immunotherapy, have made conservative, bladder-sparing strategies a viable option for managing patients with high grade T1 bladder cancer. However, many of these patients will have recurrence and occasionally progression, questioning delayed intervention. This study examines the patterns of use of IVT in high-grade T1 bladder cancer and the subsequent impact on survival for patients ultimately proceeding to radical cystectomy (RC). Patients and Methods Between 1990 and 2005, 104 patients were identified with T1 high-grade transitional cell carcinoma (TCC) who underwent RC. Patients were divided into two groups; those having RC before 1998 (median year of surgery) and those after 1998. Trends in time from diagnosis to RC, courses of IVT, recurrence, and pathological stage were analyzed using two sample t-tests with 95% confidence intervals. Kaplan-Meier analysis was used to determine the disease-free and overall survival rates. Results Before 1998, 28 of 38 patients (74%) proceeded directly to RC with no IVT, vs. 20 of 47 (43%) after 1998 (P = 0.004). The mean number of IVT courses per patient was 0.53 before 1998 and 1.2 afterward (P = 0.016). Patients who had RC before 1998 had a 69.7% disease-free survival at 5 years, vs. 39.6% for those after 1998 (P = 0.05). Conclusions In the past 15 years, our experience indicates that patients having RC for T1 high-grade TCC after 1998 were more likely to receive IVT. These same patients had a worsening disease-free survival. In very few other cancers has disease-free survival decreased over time. We postulate that the decrease in survival might be related to an increased use of IVT.

TA T1 Low and Intermediate Transitional Cell Carcinoma of the Bladder: Recurrence Rates and the Timing of Check Cystoscopies within the First Year

Introduction: The intensity of cystoscopic follow-up in the first year for patients with superficial bladder cancer has not been clearly defined. The cystoscopic follow-up of superficial bladder cancer accounts for a considerable workload for the urologist and is also an invasive procedure with high costs. We retrospectively reviewed our experience to determine any possible criteria which can lead to reduce the frequency of check cystoscopy. Material and Methods: A retrospective study was done on 427 patients with primary stage Ta and T1 bladder cancers treated between 1998 and 2005. The pattern of recurrence in the first year was assessed and recurrence rates calculated. Results: The recurrence rate was 22% at 3 months. The recurrence rates at 6 and 9 months were 8 and 13.6% respectively. The recurrence rate at 12 months was 9.4%. For tumors with no recurrence at 3 months, the recurrence rates at 6, 9 and 12 months were 6.6, 13.4 and 8.9% respectively. With respect to stages, there was a statistically significant difference in recurrence rate stages pTa and pT1 in the first and in the third control (p = 0.001, p = 0.003) respectively. According to the recurrence rate within the first year, the difference between G1 and G2 tumors was not statistically significant regardless of the stage (p > 0.05). Conclusions: Patients with initial stage Ta or T1 grade 1 and 2 bladder cancers and negative first cystoscopy have a significantly lower recurrence rate than those with recurrence at first cystoscopy. There is a reason to change follow-up routines but in our opinion only in patients with initial low-grade carcinoma. If the third-month cystoscopy is clear, it is appropriate to perform the first check cystoscopy 1 year after initial resection.

Outcomes of Patients with Clinical T1 Grade 3 Urothelial Cell Bladder Carcinoma Treated with Radical Cystectomy

Urothelial tumors that invade the lamina propria but not the muscularis propria are a particularly problematic clinical entity. The aim of the present study was to assess the pathologic features and clinical outcomes of patients with clinical T1 grade 3 urothelial cell bladder carcinoma (UCBC) treated with radical cystectomy. We reviewed the records of 958 consecutive patients who underwent radical cystectomy and pelvic lymphadenectomy for bladder cancer at three U.S. academic centers. Of these patients, 167 (median age, 66.7 years) underwent radical cystectomy for clinical stage T1 grade 3 UCBC. The median follow-up was 33.8 months (mean +/- standard deviation: 45.9 +/- 39.2 months, range, 0.4 to 177.1) for patients alive at last follow-up. Disease recurred in 48 of 167 of patients (29.4%) and 30 of 162 patients (18.5%) died from bladder cancer. A total of 29 of 166 patients (17.5%) had lymph nodal metastases. Of 167 patients, 84 (50%) were pathologically upstaged and 167 (27.5%) had extravesical disease. Patients with disease upstaging had poorer survival (P <0.001). A greater than 3-month delay between cystectomy and last transurethral resection showed a trend toward upstaging (P = 0.06). Presence of carcinoma in situ (CIS) was the only precystecomy factor that predicted disease recurrence (hazard ratio [HR]: 2.13, 95% confidence interval [CI]: 1.14 to 3.98) and mortality (HR: 2.75, 95% CI: 1.17 to 6.46). A large proportion of patients undergoing cystectomy for clinical T1 grade 3 disease have adverse pathological features. The recurrence and survival outcomes in this group are suboptimal. Presence of CIS precystectomy predicts outcomes. Better markers are needed to identify patients at high risk for adverse outcomes.

Retrospective Analysis of Transurethral Resection, Second-Look Resection, and Long-Term Chemo-Metaphylaxis for Superficial Bladder Cancer: Indications and Efficacy of a Differentiated Approach

Because of controversy concerning risk factors for progression, recurrence, and persistence of bladder cancer, we reviewed the data of our patients with superficial bladder tumors. Based on a differentiated approach with second-look transurethral resection (TUR) and/or intravesical metaphylaxis, we wanted to answer the following questions: Was this approach efficient? What risk factors demand a second-look TUR? Is surveillance appropriate for patients at low risk? Retrospectively we analyzed the data of 251 patients with superficial bladder cancer with a mean follow-up time of 69 (range 20 to 107) months. We focused on recurrence rates, tumor-persistence and progression, and types of adjuvant treatment. An early reintervention within 6 to 8 weeks after primary resection was defined as a second-look TUR. To judge the necessity of early reintervention and metaphylaxis, we performed a matched-pair analysis for the low-risk group. Tumor stages included T(a) (170 patients, 68%); T(1) (72 patients, 29%); carcinoma in situ (CIS) (9 patients, 4%). Grades included grade 1 (58 patients, 23%); grade 2 (117 patients, 47%); and grade 3 (76 patients, 30%). Thirty-eight (15%) tumors were already classified as recurrent. A second-look TUR was performed on 222 (88%) patients, indicating a persistence rate of 25%. Persistence rates for low-risk tumors (T(a) grade 1/2) were 9%; rates for T(a) grade 3 tumors were significantly higher. Risk factors for persistence were multilocularity and higher grade and stage. Matched-pair analysis for the low-risk group did not show any significant advantage for second-look TUR. After complete resection of T(1) grade 3 tumors, the risk of progression is similar to that for tumors of lower grade and stage. The overall recurrence rate was 25%, with a higher risk of upstaging in cases of higher stage or grade and multilocular and persisting tumors. The overall tumor recurrence rate of 25% reflects the efficacy of our differentiated approach with selective use of second-look TUR and intravesical metaphylaxis (intravesical chemotherapy). Second-look TUR is indicated for multifocal and recurrent tumors or in patients whose tumors put them at high risk. Patients with grade 2/3 tumors, multifocal grade 1 tumors, and all T(1) tumors received metaphylaxis; intravesical bacillus Calmette-Guerin was instilled in patients with CIS. With this regimen, even in T(1) grade 3 stages, organ preservation can be achieved.

The increasing use of intravesical therapies for stage T1 bladder cancer coincides with decreasing survival after cystectomy

Intravesical therapy (IVT), chemo and immunotherapy, has made conservative, bladder-sparing strategies a viable option for managing patients with high grade T1 bladder cancer. However, many of these patients will have recurrence and occasionally progression, questioning delayed intervention. This study examines the patterns of use of IVT in high-grade T1 bladder cancer and the subsequent impact on survival for patients ultimately proceeding to radical cystectomy (RC). Between 1990 and 2005, 104 patients were identified with T1 high-grade transitional cell carcinoma (TCC) and who underwent RC. Patients were divided into two groups; those having RC before 1998 (median year of surgery) and those after 1998. Trends in time from diagnosis to RC, courses of IVT, recurrence and pathological stage were analysed using two-sample t-tests with 95% confidence intervals. Kaplan-Meier analysis was used to determine the disease-free and overall survival rates. Before 1998, 28 of 38 patients (74%) proceeded directly to RC with no IVT, vs 20 of 47 (43%) after 1998 (P = 0.004). The mean number of IVT courses per patient was 0.53 before 1998 and 1.2 afterward (P = 0.016). Patients who had RC before 1998 had a 69.7% disease-free survival at 5 years, vs 39.6% for those after 1998 (P = 0.05). In the past 15 years, our experience indicates that patients having RC for T1 high-grade TCC after 1998 were more likely to receive IVT. These same patients had a worsening disease-free survival. In very few other cancers has disease-free survival decreased over time. We postulate that the decrease in survival might be related to an increased use of IVT.

1511: Outcomes of Patients with Clinical T1 Grade 3 Bladder Urothelial Cell Bladder Carcinoma Treated with Radical Cystectomy

You have accessJournal of UrologyPodium 43, Tuesday, May 22, 2007, 1:00 - 3:00 pm1 Apr 20071511: Outcomes of Patients with Clinical T1 Grade 3 Bladder Urothelial Cell Bladder Carcinoma Treated with Radical Cystectomy Amit Gupta, Shahrokh F. Shariat, Matthew Nielson, Patrick J. Bastian, Ganesh S. Palapattu, Craig G. Rogers, Amnon Vazina, Pierre I. Karakiewicz, Mark P. Schoenberg, Seth P. Lerner, Arthur I. Sagalowsky, and Yair Lotan Amit GuptaAmit Gupta More articles by this author , Shahrokh F. ShariatShahrokh F. Shariat More articles by this author , Matthew NielsonMatthew Nielson More articles by this author , Patrick J. BastianPatrick J. Bastian More articles by this author , Ganesh S. PalapattuGanesh S. Palapattu More articles by this author , Craig G. RogersCraig G. Rogers More articles by this author , Amnon VazinaAmnon Vazina More articles by this author , Pierre I. KarakiewiczPierre I. Karakiewicz More articles by this author , Mark P. SchoenbergMark P. Schoenberg More articles by this author , Seth P. LernerSeth P. Lerner More articles by this author , Arthur I. SagalowskyArthur I. Sagalowsky More articles by this author , and Yair LotanYair Lotan More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)31712-9AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "1511: Outcomes of Patients with Clinical T1 Grade 3 Bladder Urothelial Cell Bladder Carcinoma Treated with Radical Cystectomy." The Journal of Urology, 177(4S), pp. 498–499 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 177Issue 4SApril 2007Page: 498-499 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Amit Gupta More articles by this author Shahrokh F. Shariat More articles by this author Matthew Nielson More articles by this author Patrick J. Bastian More articles by this author Ganesh S. Palapattu More articles by this author Craig G. Rogers More articles by this author Amnon Vazina More articles by this author Pierre I. Karakiewicz More articles by this author Mark P. Schoenberg More articles by this author Seth P. Lerner More articles by this author Arthur I. Sagalowsky More articles by this author Yair Lotan More articles by this author Expand All Advertisement PDF downloadLoading ...

Poliartritis secundaria a instilaciones intravesicales de BCG, a propósito de un caso

Immunotherapy with intravesical instillation of Bacillus Calmette is the best complementary after TUR treatment against T1 grade 2- 3 and CIS bladder cancer. However, this therapy is associated with several side- effects, incluiding joint symptoms. In this article we describe a case of polyarthritis associated with intravesical instillation, a rare complication. We review the clinical features, the pathogenic mechanisms and treatments described previously in the medical literature. Finally, we expose our brief experience and our final result.

Radiochemotherapy After Transurethral Resection for High-Risk T1 Bladder Cancer: An Alternative to Intravesical Therapy or Early Cystectomy?

For high-risk T1 bladder cancer, the most important issue is how to restrict radical cystectomy to selective patients with a high likelihood of tumor progression and to choose an initial bladder-sparing approach in others without affecting survival. Radiotherapy or radiochemotherapy (RT/RCT) may help to strike a balance between intravesical treatment and early cystectomy. Between 1982 and 2004, 141 patients with high-risk T1 bladder cancer (84 patients with T1 grade 3 [T1G3]; others with T1G1/2 and associated carcinoma-in-situ, multifocality, tumor diameter > 5 cm, or multiple recurrences) were treated with RT (n = 28) or platinum-based RCT (n = 113) after transurethral resection of bladder tumor (TURBT). Six weeks after RT/RCT, response was evaluated by restaging TURBT. Salvage cystectomy was recommended for patients with persistent disease and for tumor progression after initial complete response (CR). Median follow-up was 62 months; 65 patients have been observed for 5 years or more. CR was achieved in 121 of 137 patients (88%; four patients without restaging TURBT). Tumor progression for the entire group of 141 patients was 19% and 30% at 5 and 10 years, respectively (for 121 patients with CR, 15% and 29%; for 84 patients with T1G3, 13% and 29%, respectively). Disease-specific survival rates were 82% and 73% at 5 and 10 years (CR, 89% and 79%; T1G3, 80% and 71%, respectively). More than 80% of survivors preserved their bladder; 70.4% were "delighted" or "pleased" with their urinary function. RT/RCT after TURBT with selective bladder preservation is a reasonable alternative to intravesical treatment or early cystectomy for high-risk T1 bladder cancer.

The Effect of Repeat Transurethral Resection on Recurrence and Progression Rates in Patients With T1 Tumors of the Bladder Who Received Intravesical Mitomycin: A Prospective, Randomized Clinical Trial

We compared the outcomes of repeat transurethral resection plus intravesical mitomycin C with initial transurethral resection of bladder plus intravesical MMC in patients with newly diagnosed pT1 transitional cell carcinoma of the bladder in terms of recurrence, progression and overall survival. Of 148 newly diagnosed patients with T1 bladder cancer 142 were prospectively randomized in 2 groups between January 2001 and January 2005. A total of 74 patients underwent second TURB and received adjuvant MMC intravesically (group 1) and 68 patients received adjuvant MMC following the initial TURB (group 2). All repeat TURB operations were performed 2 to 6 weeks following initial TURB. Patients with incomplete resection, Cis or muscle invasive disease were excluded from study. The first dose of mitomycin C (40 mg per week for a total of 8 weeks) was instilled intravesically in all patients during the first 24 hours after the last surgery. Mean followup was 31.5 months (range 6 to 48) with no difference between the 2 groups. The rate of recurrence-free survival was 86.35% (SE 0.4%), 77.67% and 68.72% in group 1, and 47.08%, 42.31% and 37.01% in group 2 for the first, second and third year, respectively (overall 74.32% vs 36.76%, log rank 0.0001). Recurrence was observed in 19 of the 74 (25.68%) patients in group 1 and in 43 of the 68 (63.24%) patients in group 2. Ten of the 19 (52.63%) patients in group 1 and 35 of the 43 (81.39%) patients in group 2 had recurrence within 12 months. Recurrence was observed in 17.6%, 25% and 60% of patients with G1, G2 and G3 tumors, respectively, in group 1. The same rates for group 2 were 25%, 64% and 90%. The RFS rate was significantly worse in the high grade group (G2 and G3) (p <0.001). Progression was observed at 4.05% for group 1 compared to 11.76% for group 2 (log rank 0.0974). OS was 91.89% and 89.71% in group 1 and 2, respectively (log rank 0.732). The high recurrence rate in patients who did not undergo ReTUR is due to a high residual tumor rate following initial TURB. The benefit of ReTUR is especially true for high grade tumors. Since intravesical MMC was present in both groups, this study has shown that intravesical chemotherapy does not compensate for inadequate resection. Progression does not seem to be affected by ReTUR although there was a trend favoring the ReTUR group. We recommend ReTUR for patients with primary high grade T1 disease to achieve better recurrence-free survival.

Is a Second Transurethral Resection Necessary for Newly Diagnosed pT1 Bladder Cancer?

We evaluated the potential benefit of a second transurethral resection in patients with newly diagnosed pT1 transitional cell carcinoma of the bladder. Between January 2001 and May 2003, 80 patients with stage T1 bladder cancer were included in this protocol in which all patients prospectively received second TUR within 2 to 6 weeks following the initial resection. Patients with incomplete resections were excluded from study. The pathological findings of the second TUR were reviewed. Of the 80 patients who underwent second resection, 18 (22.5%) had macroscopic tumors before resection. However, with the addition of microscopic tumors, overall residual disease was determined in 27 (33.8%) patients. Of the 27 patients 7 had pTa, 14 had pT1, 3 had pT1+pTis and 3 had pT2 disease. Residual cancers were detected in 5.8%, 38.2% and 62.5% in G1, G2 and G3 tumors, respectively. The risk of residual tumor directly correlated with the grade of the initial tumor (p = 0.009). Although second TUR dramatically changed the treatment strategy in a small percentage of cases, we strongly recommend performing second TUR in all cases of primary pT1 disease, especially in high grade cases.

The Role of the Surgeon and Transurethral Resection in the Treatment of Superficial Bladder Cancer

Non-muscle invasive bladder cancers are a heterogeneous group of cancers whose spectrum includes low grade Ta lesions and high-grade T1 lesions. Accurate staging and grading during initial evaluation and TUR ensures appropriate treatment and prevents the risk of understaging. TUR should be ideally performed under spinal anesthesia, with a continuous flow video resectoscope to maintain a stable bladder capacity, and a video monitor. The entire bladder must be visualized, with both 30- and 70-degree lenses, and all abnormal areas must be resected, with separate biopsies from each tumor's base. Repeat TUR is recommended for all high grade tumors and T1 tumors, especially if muscle was not present in the initial specimen. Immediate instillation of single dose chemotherapy agents following TUR is highly recommended to reduce the risk of tumor recurrences.

Risk Factors for Upper Tract Recurrence in Patients Undergoing Long-Term Surveillance for Stage Ta Bladder Cancer

While the evidence is clear that patients with carcinoma in situ or high grade T1 TCC of the bladder are at higher risk for developing UUT tumors, the role of imaging the UUT in patients with Ta tumors remains controversial. We hypothesized that the number and frequency of recurrences in patients with Ta disease would allow us to identify a population who should undergo routine UUT surveillance. We reviewed our database of 375 patients who underwent resection of a stage Ta TCC between 1975 and 1995. Median followup was 6 years. Patients were stratified according to the presence of an UUT occurrence, rate and timing of superficial recurrences, and grade of the initial bladder tumor. Among the 375 patients 50% had no bladder recurrence, 25% had 1 tumor, 15% had 2 tumors, and 10% had 3 or more tumors. Average time between tumors was 17 months. UUT tumor developed in 13 patients (3.4%) at an average of 22 months after their initial bladder tumor. A high risk group consisting of patients who had 2 or more bladder recurrences recurring within 12 months of each other were at 4.5-fold the risk of UUT tumor. Stage Ta bladder cancer patients with 2 or more recurrences of bladder tumors with a median of less than 12 months between recurrences are at higher risk for developing an UUT tumor and should be considered for more frequent UUT surveillance.

RESTAGING TRANSURETHRAL RESECTION OF HIGH RISK SUPERFICIAL BLADDER CANCER IMPROVES THE INITIAL RESPONSE TO BACILLUS CALMETTE-GUERIN THERAPY

This study was an evaluation of whether restaging transurethral resection (TUR) of superficial bladder cancer improves the early response to bacillus Calmette-Guerin (BCG) therapy. A total of 347 patients with high risk superficial bladder cancer (high grade Ta and T1 tumors associated with carcinoma in situ) underwent a single transurethral resection (TUR, 132 patients) or restaging TUR (215 patients) before receiving 6 weekly intravesical BCG treatments. The patients were evaluated for response (presence or absence of tumor) at first followup cystoscopy, at 6 and 12 months after treatment, and evaluated for disease stage progression within 3 years of followup. Of the 132 patients who underwent a single TUR before BCG therapy, 75 (57%) had residual or recurrent tumor at the first cystoscopy and 45 (34%) later had progression, compared with 62 of 215 patients (29%) who had residual or recurrent tumors and 16 (7%) who had progression after undergoing restaging TUR (p = 0.001). Restaging TUR of high risk superficial bladder cancer improves the initial response rate to BCG therapy, reduces the frequency of subsequent tumor recurrence and appears to delay early tumor progression.

Praxis der intravesikalen Instillationsprophylaxe beim oberflächlichen Harnblasenkarzinom - Ergebnisse einer Umfrage in Sachsen

For patients with superficial bladder cancer, adjuvant intravesical chemotherapy or immunotherapy with Bacillus Calmette-Guerin (BCG) is recommended in national and international guidelines. We analyzed whether the recommended therapeutic regimens are used in daily urological practice. Questionnaires concerning the adjuvant intravesical therapy were sent to 152 urologists in the German Federal State of Saxony. Of the surveyed physicians, 134 practiced in an outpatient medical facility and 18 in a hospital. Of the questionnaires, 73 (48.02 %) were returned and evaluated. An adjuvant intravesical therapy after transurethral bladder tumor resection was performed in every second patient (median value 50.07 %). The majority of the urologists (79.4 %) treated the bladder tumors with intravesical chemotherapy or BCG depending on tumor stage and grade of malignancy. Chemotherapeutic agents or BCG was exclusively used in 13.6 % and 4.1 % of treated patients, respectively. Chemotherapeutic agents were predominantly applied up to the primary tumor stage T1 and malignancy grade G2. In cases with recurrent T1 bladder tumors of G2 or higher grade of malignancy, BCG was the main agent for intravesical treatment. In patients with recurrent T1G3 tumors, the majority of urologist (57.1 %) preferred another therapeutic regimen than intravesical instillation. Only 23.2 % of the urologists believed that intravesical BCG is superior to chemotherapeutic agents. These data demonstrate that adjuvant intravesical instillation with chemotherapeutic agents and BCG is well established in urological practice. In contrast to the recommendations of national and international guidelines, chemotherapeutic agents are more frequently used in cases with a high risk of progression.

T1 G3 bladder cancer: A second-look endoscopic resection can help achieve a correct staging of a “superficial-invasive” tumor

4651 Background: About one third of urothelial bladder cancers is staged as T1. High grade (G3) T1 tumors present elevated recurrence and progression rates, with a metastatic and lethal potential t...