Society Of Urologic Oncology Meeting - When Is It Time To Treat The Patient And Not The Bladder?

Main Category: Urology / Nephrology
Also Included In: Cancer / Oncology;  MRI / PET / Ultrasound;  Conferences
Article Date: 31 May 2008 - 0:00 PDT

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ORLANDO, FL (UroToday.com) - Dr. Bochner outlined the dilemma of T1G3 bladder cancer. IT is a lethal disease if conservative therapies are too liberally pursued. A thorough risk assessment must be performed, starting with restaging TURBT, detailed pathological review and optimal imaging prior to the TURBT and a bimanual examination.

Risk factors include morphologic and pathologic characteristics. Sessile T1 lesions do significantly worse than papillary T1 lesions. The number of tumors and size of tumors also influence outcome. Location is also important, as some are difficult to access with the cystoscope and may not be completely removed. T1 sub-staging is shown to predict progression, but consistent pathologic interpretation is variable. The presence of CIS in addition to T1 disease increases the risk of progression from 29% to 45%.

The EORTC risk tables permits quantification of risk factors and estimates their risk of progression. Lymphovascular invasion results in a 3-fold increased risk over time of disease progression. Micropapillary histology was associated with a 67% risk of intravesical therapy failure and should perhaps be considered for cystectomy.

Molecular markers may offer further risk identification, but require further development. He cited Dr. Herr's data that persistent T1 disease on restaging TUR had a much higher risk of progression and ultimately treatment failure. Cystectomy at time of progression treated at less than 2 years had a 41% 5-year survival compared to 18% if cystectomy is performed after 2 years. He pointed out that once TCC has progressed to T2 disease, the 5-year survival decreases to 29% from 55% had the cystectomy been performed prior to progression.

Presented by Bernard Bochner, MD, at the Annual Meeting of the American Urological Association (AUA) - May 17 - 22, 2008. Orange County Convention Center - Orlando, Florida, USA.

Reported by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS

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