Selection Of Patients For ReTURBT In Patients Presenting With Presumed Non-Muscle Invasive Bladder Cancer

Main Category: Urology / Nephrology
Also Included In: Cancer / Oncology;  Clinical Trials / Drug Trials
Article Date: 26 Sep 2008 - 3:00 PDT

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BERLIN, GERMANY (UroToday.com) - S. Machele Donat, MD, Associate Attending Surgeon, Memorial Sloan-Kettering Cancer Center, presented the MSKCC experience with reTURBT in patients presenting with presumed non-muscle invasive bladder cancer.

In patients presumed to be Tcis at initial resection, 30% were found to be P0, 40% were Pa/Pcis, 20% were P1 and 10% were P2 at reTURBT.

In patients who were Ta at initial resection, 28% were P0, 39% Pa/Pcis, 28% P1 and 10% P2 at reTURBT.

For patients with initial T1 pathology when muscle was present, 26% were P0, 31% were Pa/Pcis, 29% were P1 and 14% were P2 at reTURBT.

Finally, and most impressive, for patients thought to be T1 but for whom no muscle was present in the original specimen, 17% were P0, 11% Pa/Pcis, 17% P1 and 49% were P2 at reTURBT!

Dr. Donat concluded that in the MSKCC experience, and in the experiences of others, there was proven benefit of re-staging TURBT. This benefit included reduced recurrence with a delay in tumor progression, improved response to intravesical therapy, and improved clinical staging translating to a more appropriate treatment selection.

She went on to indicate that reTURBT might not benefit those with solitary low grade noninvasive Ta tumors or those with already documented muscle invasive disease undergoing a radical cystectomy. Additionally, she stressed that surgical technique and experience matter. Lapses in surgical technique cannot be overcome by intravesical therapy since in her experience, and in that of others, intravesical therapy does not make up for an inadequate resection.

Lastly, Dr. Donat stated that while photodynamic diagnosis may improve recurrence rates, it has not impacted progression rates.

Presented by S. Machele Donat, MD, FACS, at the Annual Meeting of the AUA - New York Section - September 6 - 13, 2008 - Berlin, Germany

Reported by UroToday.com Contributing Editor Mitchell C. Benson, MD

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