Superficial Bladder Cancer Therapy: A Review

Most bladder cancers present as a superficial disease, confined to the bladder mucosa or submucosal layer, without muscle invasion. Most superficial tumors have a propensity for recurrence after transurethral resection; some have a high risk for progression to muscle invasion. The treatment aim in superficial bladder cancer with intravesical therapy is three-fold: (1) eradicate existing disease, (2) prevention of recurrence, (3) prevention of tumor progression. The prognostic factors (tumor stage, grade, size, number and recurrence pattern) allow the stratification of tumors in different risk groups to plan treatment. Studies on pharmacokinetics have proved the efficacy of optimized drug delivery. Comparing resection with and without intravesical chemotherapy, a short-term reduction, approximately 15%, in tumor recurrence with chemotherapy can be obtained, but no effect on progression was proven. No agent has proved to be more effective than the others. A single instillation of chemotherapy immediately after transurethral resection has proven to be effective, but the role of maintenance therapy is controversial. Immunotherapy, in the form of Bacillus Calmette-Guerin, is generally shown to be more effective than chemotherapy, even if the results in comparison to mitomycin C do not result conclusive. Several new approaches are being explored to improve the efficacy of this therapy.

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The Role of Urinary Fibronectin and Telomerase in Patients with Superficial Bladder Cancer after Transurethral Resection Treated with BCG

Bulletin of Egyptian Society for Physiological Sciences ◽

10.21608/besps.2010.36166 ◽

2010 ◽

Vol 30 (1) ◽

pp. 73-102

Author(s):

Ghada Abdel Aleem ◽

Hala Hamouda ◽

Tarek Gameel ◽

Mona Abdel-Azem

Keyword(s):

Bladder Cancer ◽

Transurethral Resection ◽

Superficial Bladder Cancer

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Intravesical bacillus Calmette-Guérin therapy prevents tumor progression and death from superficial bladder cancer: ten-year follow-up of a prospective randomized trial.

Journal of Clinical Oncology ◽

10.1200/jco.1995.13.6.1404 ◽

1995 ◽

Vol 13 (6) ◽

pp. 1404-1408 ◽

Cited By ~ 220

Author(s):

H W Herr ◽

D M Schwalb ◽

Z F Zhang ◽

P C Sogani ◽

W R Fair ◽

...

Keyword(s):

Bladder Cancer ◽

Tumor Progression ◽

Superficial Bladder Cancer ◽

Metastatic Cancer ◽

Tumor Resection ◽

Intravesical Therapy ◽

Control Group ◽

Bacillus Calmette Guerin ◽

Risk Patients ◽

Muscle Invasion

PURPOSE Superficial bladder tumors (stage Ta, T1, and Tis) may progress to invade the bladder muscle and cause death from metastatic cancer. Transurethral tumor resection (TURB) is the standard therapy for such tumors, but surgery alone may not prevent tumor progression. Intravesical therapy is widely used as an adjunct to TURB. Bacillus Calmette-Guérin (BCG) is the most active intravesical agent, but whether BCG prevents tumor progression and death from bladder cancer is unknown. PATIENTS AND METHODS Between 1978 and 1981, 86 high-risk patients with superficial bladder cancer were randomly assigned to receive either TURB (n = 43) or TURB plus BCG (n = 43). Adverse tumor features for progression were equally distributed between the two groups. BCG was administered weekly for 6 weeks. Patients were evaluated every 3 to 6 months thereafter for progression to muscle invasion or metastasis. Control (TURB) patients with recurrent superficial tumors were eligible for crossover to the BCG arm. All patients have been monitored until event or for a minimum of 10 years (range, 10 to 14). RESULTS The 10-year progression-free rate was 61.9% (95% confidence interval [CI], 47.2% to 76.7%) for patients treated with BCG and 37% (95% CI, 22.9% to 53.1%) for control patients. The median progression-free interval was not reached for the BCG group and was 46 months for the control group (P = .0063). Of 18 control patients crossed over to BCG (median, 29 months), 15 did not show tumor progression. TURB plus BCG resulted in a 10-year disease-specific survival rate of 75%, compared with 55% with TURB alone (P = .03). CONCLUSION This study shows that intravesical therapy with BCG delays tumor progression and death from tumor in patients who present with superficial bladder cancer.

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

TSW Urology ◽

10.1100/tswurol.2006.126 ◽

2006 ◽

Vol 1 ◽

pp. 24-29

Author(s):

Alan M. Nieder ◽

Murugesan Manoharan

Keyword(s):

Bladder Cancer ◽

Transurethral Resection ◽

Superficial Bladder Cancer

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Which Non-Muscle Invasive Bladder Cancer Is More Valuable For Re-transurethral resection?

10.22541/au.161806198.84400996/v1 ◽

2021 ◽

Author(s):

Murat Akgul ◽

Cagri Dogan ◽

Cenk Murat Yazıcı ◽

Mehmet ŞAHİN ◽

Aysegul Arslan ◽

...

Keyword(s):

Bladder Cancer ◽

High Risk ◽

Transurethral Resection ◽

Tumor Stage ◽

Invasive Bladder Cancer ◽

Residual Tumour ◽

Muscle Invasive Bladder Cancer ◽

Factors Affecting ◽

Size Number ◽

Muscle Invasive

INTRODUCTION: We evaluated the re-transurethral resection (re-TUR) pathologies and the comparison of pathology results between transurethral resection of bladder (TUR-B) and re-TUR for non-muscle invasive bladder cancer (NMIBC). Additionally we assessed the factors affecting the re-TUR pathology and tried to define the more valuable re-TUR patient groups. We also aimed to evaluate the effect of re-TUR on recurrence and progression. METHODS: We performed re-TUR to intermediate/high risk NMIBC patients, 4-6 weeks after the index TUR-B. Both TUR-B and re-TUR pathology characteristics, including tumor stage, grade, size, number, lymphovascular invasion (LVI), carcinoma in situ (CIS), variant pathology and intermediate/high risk status were analysed. The recurrence and progression rates were also evaluated according to re-TUR. RESULTS: A total of 78 patients with NMIBC were included to the study. The index TUR-B pathologies were Ta-Low: 6 (7,7%), Ta-High: 5 (6,4%), T1-Low: 14 (17,9%), T1-High: 53 (67,9%). Re-TUR positivity was n: 40 (51 %), and upstaging/upgrading at re-TUR was n: 11 (14 %) in all groups. Re-TUR positivity was significantly higher in high-risk compared to intermediate-risk NMIBC (p:0,026). Re-TUR positivity was higher in patients with hydronephrosis, CIS, LVI, differentiation, size (>3 cm) and multiple tumour presence (p<0,05). There was no significant relationship between recurrence / progression and re-TUR (p>0,05). CONCLUSION: Residual tumour was common after the index TUR-B and upstaging after re-TUR was very important. Re-TUR is critically important in high-risk NMIBC, presence of hydronephrosis, CIS, LVI, variant pathology, size (>3 cm) and multiple number of tumor.

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Organ conservation in T2-3 bladder cancer: the role of transurethral resection, partial cystectomy, and primary and adjuvant chemotherapy

World Journal of Urology ◽

10.1007/bf00186082 ◽

1992 ◽

Vol 10 (1) ◽

Cited By ~ 2

Author(s):

C.N. Sternberg

Keyword(s):

Bladder Cancer ◽

Adjuvant Chemotherapy ◽

Transurethral Resection ◽

Partial Cystectomy

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Results of Transurethral Resection Plus Adjuvant Intravesical Chemotherapy for Superficial Bladder Cancer

International Journal of Urology ◽

10.1111/j.1442-2042.1998.tb00407.x ◽

1998 ◽

Vol 5 (6) ◽

pp. 534-539 ◽

Cited By ~ 3

Author(s):

Masashi Nomi ◽

Kazuo Gohji ◽

Masayuki Okamoto ◽

Atsushi Takenaka ◽

Yoshiharu Ono ◽

...

Keyword(s):

Bladder Cancer ◽

Transurethral Resection ◽

Superficial Bladder Cancer ◽

Intravesical Chemotherapy

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RECURRENCE RATE AFTER REPEAT TRANSURETHRAL RESECTION AMONG PATIENTS WITH NEWLY DIAGNOSED T1 BLADDER CANCER

10.36106/ijar/7213765 ◽

2021 ◽

pp. 51-54

Author(s):

Md. Shafiqur Rahman ◽

Sanjeeb Bhakta Bista ◽

Md. Sayedul Islam ◽

A. S. M. Shafiul Azam ◽

Md. Shamim Hossain ◽

...

Keyword(s):

Bladder Cancer ◽

Recurrence Rate ◽

Transurethral Resection ◽

Tumor Recurrence ◽

Controlled Trial ◽

Intravesical Therapy ◽

Newly Diagnosed ◽

Group I ◽

Group Ii

Background: Transurethral resection of the bladder tumor (TURBT) is the cornerstone of diagnosis and TURBT followed by selective adjuvant intravesical chemotherapy or immunotherapy is the gold standard of treatment for the patients with non-muscle invasive bladder cancer (NMIBC). Even after complete resection of the tumor there is high risk of residual tumor and subsequent recurrence and progression of the disease. The recurrence of T1 tumor is found to be around 71 % within 5 years and High grade T1 lesions recur in more than 80% of the cases and progress in 50% of the patients within 3 years. Disease status at 3 months after initial resection is an important predictor of subsequent recurrence and progression. To assess the tumor recurrence rat Objective: e among patients with newly diagnosed T1 bladder cancer between repeat transurethral resection group and single TURBT group. Ra Type of study: ndomized controlled trial. Place of study: Department of urology, BSMMU, Dhaka, Bangladesh. This Randomi Materials And Methods: zed Controlled Trial was conducted in urology department of BSMMU, Dhaka, Bangladesh from February 2017 till September 2018. A total of 50 patients, diagnosed as a case of T1 bladder cancer and who fulll the selection criteria were randomly divided in two groups consisting of 25 patients in each group. After informed consent, repeat TUR was done after 4 weeks of the initial TURBT for only 22 patients in group I since 3 of the patients did not show up on the scheduled date of surgery. Whereas, repeat TUR was not done for other 25 patients in group II. All the patients in both the groups were further treated with intravesical therapy according to the histopathological report. The patients in both the groups were followed up at 3 months and 6 months of the initial intervention where detailed history was taken, relevant investigations were done and check cystoscopy was done. TURBT was done for recurrent tumors. Out of 22 patients in group I, 2 patients were excluded for follow up on the basis of repeat TUR ndings. Whereas in group II, 2 patients missed the follow up and one of them missed the normal scheduled dose of intravesical therapy. Hence, 22 patients completed the study in group II. The baseline variables like age and Results: sex were similar in both the groups with higher male predominance. There was no statistical signicant difference in tumor characteristics such as size, number and grade of the tumor between the two groups. Out of 22 patients in group I who underwent repeat TUR at 4 weeks of initial TUR, residual disease was found in 8 (36.36%) patients. One of the patient was found to have T2 disease and 1 patient had CIS during repeat TUR. These 2 patients were not followed up since the treatment strategy changed after the results of repeat TUR. After 6 months of follow up of all the patients, 2 (10%) out of 20 patients in group I were found to have tumor recurrence however, in group II, 9 (40.9%) patients had tumor recurrence. The tumor recurrence rate between the two groups was found to be statistically signicant (p=0.023). In the light of ndings of this Conclusion: study, it can be concluded that performing repeat transurethral resection in patients with newly diagnosed T1 bladder cancer at 4 weeks of initial TURBT, helps to detect signicant number of residual tumor and reduce early recurrence rate of the tumor.

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