ABSTRACT
Bladder cancer is the most common malignancy of the urinary tract. Approximately 75% of patients present with a non-muscle-invasive bladder tumors. It is recommended to perform a second resection [Re-TURBT] of T1, and high grade tumors after 2-6 weeks from the initial TURBT. This retrospective study was performed to determine the role of re-resection [Re-TURBT] of non-muscle invasive T1 bladder cancer after 4-6 weeks from the first resection. From January 2011 to December 2013, we retrospectively evaluated 108 patients with primary T1 TCC [transitional cell carcinoma] bladder cancer. Re-TURBT was performed in 70 patients [group A] after 4-6 weeks from initial TURBT, 38 underwent regular follow up without re-resection [group B]. A cystoscopy was performed every 3 months for 1 year in all patients. Both groups [A+B] received 6 doses course of BCG as an adjuvant therapy. Residual disease at the second TURBT was detected in 41 patient [58.5%].Understaging in initial TURBT was found in 11 patients [15.7%], 6 [8.5%] of them were T2 and underwent cystectomy. Recurrence happened in 21 [32.8%] patients of group A [64 patients] and in 25 patients [65.7%] of group B. Progression to muscle invasive tumors in 4 [6%] in group A, in 6 [15%] in group B. Recurrence was reduced from 65.7% in group B to 32.8% in group A [p=0.001] and progression reduced from 15% to 6%, [p=0.11]. Re-TURBT has an important role in correcting understaging in initial TURBT, and it reduces recurrence and progression in patients with T1 bladder tumors. We recommend re-TURBT in T1 bladder tumor patients
ABSTRACT
Bladder cancer is the most common malignancy of the urinary tract. At the initial diagnosis of bladder cancer, approximately 30% of cases are diagnosed as muscle-invasive disease. About one third of cases that diagnosed initially as non-muscle-invasive disease progress to muscle-invasive, radical cystectomy [RC] is considered the standard treatment for these tumors. In fact, in a significant number of cases the transitional cell carcinoma [TCC] of the bladder infiltrates into prostatic tissue, in addition to the chance for the presence of occult prostatic adenocarcinoma. This study was performed to ascertain which variables of bladder cancer might be useful in predicting of involvement the prostate in radical cystectomy specimens. This approach can help in identifying bladder cancer variables that could guide urologists in the selection of patients who may be candidates for prostatesparing cystectomy [PSC]. We retrospectively reviewed the results of 150 patients treated by RC for advanced bladder cancer. We documented the variables of these tumors and its pathological results in regard of infiltration to the prostatic urethra and to the prostate. The cancer was present in the prostatic urethra in 15 patients [10%] and in the prostate in 39 patients [26%], altogether in 54 patients [36%]. Infiltration was found in 38 patients from 65 with history of recurrence [58.46%]. In primary tumors, only 18.82% [16 of 85 patients] were infiltrated. Infiltration was found in 35 patients from 72 with multifocal tumor [48.6%]. The infiltration rate was 66.66% in tumors located in bladder neck and trigon [14 from 21 patients]. Infiltration was again very prominent in carcinoma in-situ [CIS] [75%] and in high grade cancer [38.7%]. In addition 12 cases [8%] of primary adenocarcinoma of prostate were identified. Our study can help in identifying bladder cancer variables that could guide urologists in the selection of most appropriate surgical procedure, especially in regard to prostate-sparing cystectomy. It is not advisable to perform PSC when the tumors are of high grade, recurrent or progressive, multiple, located in the trigon and bladder neck, or presence of CIS
ABSTRACT
Background: Studies of European Organization for Research and Treatment of Cancer are very important; they have designed risk tables and score depending on clinical and pathologic features of the tumor. Purpose: Identifying the concordance of EORTC criterions in bladder tumors in our patients by studying recurrence rate and its accordance with the similar studies of EORTC. Material and Methods: A retrospective study contains all superficial bladder tumors patients treated by TURBT at Al Assad University Hospital during 2003-2004, to identify the recurrent cases by using EORTC criterions, The patient`s files were analyzed for 5 years. There were 114 patients, 109 males and 5 females, 80 of them were younger than70 years old. The patients were classified according to tumors number, size, prior recurrence rate, grade, stage and presence of CIS complex. We have calculated Recurrence probabilities according to EORTC system, points concerning this score and real recurrence rate. Results: 48.1% have single tumor, 47% have 2-7 lesions. 77.9% have tumor less than 3 cm. 47.7% were primary tumors. 82.6% of these tumors were T1 and 17.4% were Ta. 67.1% of them were G2. CIS was found in 2.7% of patients. There were 56 patients with 1-4 points, 75 with 5-9 points and 17 with 10-17 points. Real recurrence rate after one year of TURBT was 25-70.6% and 44.6-94.1% after 5 years. There was a concordance between our study and EORTC studies in the patients of 1-9 points on EORTC score, our patients of 10-17 points have a larger recurrence rate. Conclusion: EORTC score is suitable to predict recurrence in superficial bladder tumors, and can be used in every patient, interval between periodic cystoscopies with patients of high score should not be long because recurrence probabilities increase with time