UroToday- This article published in the September issue of Urology details the feasibility of bladder preservation with muscle-invasive cancer using transurethral resection alone. The authors evaluated 327 patients with muscle-invasive bladder cancer who were treated in at M.D. Anderson from 1997 to 2002. Repeat bladder tumor resection was repeated in all patients. If the patient had no residual tumor on biopsy, normal examination under anesthesia, and normal upper urinary tracts bladder preservation was offered. Patients who opted for bladder preservation by transurethral resection alone did not receive intravesical therapy and were followed up by routine cystoscopy for a median of 2.45 years.

Of 327 patients, 35 (11%) were eligible for bladder preservation, 27 elected to pursue this approach and 8 opted for immediate cystectomy. Of the 8 that underwent immediate cystectomy 4 had no residual tumor and one died from metastatic disease. Of the 27 patients who did have bladder preservation, 15 experienced subsequent tumor recurrence, 8 of whom underwent radical cystectomy. Of the 8 that had a delayed cystectomy 4 had node positive disease and 5 had extravesical disease. Only one of the delayed cystectomy patients had organ-confined disease without nodal extension and that person underwent neoadjuvant chemotherapy. The overall and disease-specific survival rate was 81% and 93%, respectively but 2 are alive with metastatic disease.

Bladder preservation using transurethral resection is feasible in selected patients, only 11% of the eligible population. Unfortunately, despite close surveillance 30% needed a cystectomy and of these 8 patients 50% had node positive disease and 62% had extravesical disease. This highlights that our current surveillance programs are inadequate to identify recurrent bladder cancer at a curable stage.

Leibovici D, Kassouf W, Pisters LL, Pettaway CA, Wu X, Dinney CP, Grossman HP

Urology. 70(3): 473- 476, September 2007
doi:10.1016/j.urology.2007.05.007

Reported by UroToday Contributing Editor David P. Wood, M.D

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