Bladder Cancer
GENERAL
Bladder cancer is the 9th most expensive cancer to treat. (5,7) At a median age of 73, it is the oldest age at diagnosis of all cancer sites. (6) 2.6% of asymptomatic hematuria work-ups result in urologic malignancy. (1)
PROGNOSIS
One study found it node positive disease after cystectomy, the 5yr OS is 31% if received neoadjuvant, 26% if adjuvant, 19% in cystectomy alone, 14% in chemotherapy alone. (9)
IMAGING
If on office cysto appears sessile, high grade or muscle invasive, recommend MRI or CT prior to TURBT. Ureteroscopy can fulfill the criteria for upper tract imaging if unable to undergo CTU or MRU. (8)
TURBT
One study of 231 patients found spinal anesthesia associated with reduced risk of recurrence with general anesthesia OR 2.06 for recurrence and HR 1.57 for earlier time to recurrence. (10) A meta-analysis of oncologic surgeries found improved overall survival advance when not using general anesthesia. (11)
REPEAT TURBT
The risk of upstaging in repeat TURBT is related to the presence or absence of muscularis propria on the initial resection specimen, with rates of upstaging varying from 40-50% among patients without muscle present on the first TURBT specimen to 15-20% in patients with muscle present at the first TURBT. (3) Meta-analysis of 15 studies of repeat TURBT showed persistence rate of 39% (19-56%) in Ta and 47% (15-55%) in T1 with upstaging in 0-14% of Ta and 0-24% in T1. (2) T1 disease found in repeat resection is associated with progression risk of nearly 80%. (3)
NBI
Studies of NBI light has not uniformly shown increased identification of bladder tumors. (3) A 2015 prospective, multicenter, RCT of white light vs. NBI showed the 12 month recurrence rate following resection were not different between the groups (27.1% in WLC group versus 25.4% in NBI group [p=0.585]). Low risk patients did show benefit from NBI (27.3% in WLC group versus 5.6% in NBI group [p=0.002]), but the low-risk group was not well defined. (3,4)
Bladder cancer is the 9th most expensive cancer to treat. (5,7) At a median age of 73, it is the oldest age at diagnosis of all cancer sites. (6) 2.6% of asymptomatic hematuria work-ups result in urologic malignancy. (1)
PROGNOSIS
One study found it node positive disease after cystectomy, the 5yr OS is 31% if received neoadjuvant, 26% if adjuvant, 19% in cystectomy alone, 14% in chemotherapy alone. (9)
IMAGING
If on office cysto appears sessile, high grade or muscle invasive, recommend MRI or CT prior to TURBT. Ureteroscopy can fulfill the criteria for upper tract imaging if unable to undergo CTU or MRU. (8)
TURBT
One study of 231 patients found spinal anesthesia associated with reduced risk of recurrence with general anesthesia OR 2.06 for recurrence and HR 1.57 for earlier time to recurrence. (10) A meta-analysis of oncologic surgeries found improved overall survival advance when not using general anesthesia. (11)
REPEAT TURBT
The risk of upstaging in repeat TURBT is related to the presence or absence of muscularis propria on the initial resection specimen, with rates of upstaging varying from 40-50% among patients without muscle present on the first TURBT specimen to 15-20% in patients with muscle present at the first TURBT. (3) Meta-analysis of 15 studies of repeat TURBT showed persistence rate of 39% (19-56%) in Ta and 47% (15-55%) in T1 with upstaging in 0-14% of Ta and 0-24% in T1. (2) T1 disease found in repeat resection is associated with progression risk of nearly 80%. (3)
NBI
Studies of NBI light has not uniformly shown increased identification of bladder tumors. (3) A 2015 prospective, multicenter, RCT of white light vs. NBI showed the 12 month recurrence rate following resection were not different between the groups (27.1% in WLC group versus 25.4% in NBI group [p=0.585]). Low risk patients did show benefit from NBI (27.3% in WLC group versus 5.6% in NBI group [p=0.002]), but the low-risk group was not well defined. (3,4)
- Davis R, Jones JS, Barocas DA et al: Diagnosis, evaluation and follow-up of asymptomatic microhematuria (AMH) in adults: AUA guideline. J Urol 2012;188:2473.
- Vianello A, Costantini E, Del Zingaro M et al: Repeated white-light transurethral resection of the bladder in nonmuscle-invasive urothelial bladder cancers: systematic review and meta-analysis. J Endourol 2011;25:1703.
- Diagnosis and Treatment of Non-Muscle Invasive Bladder Cancer: AUA/SUO Joint Guideline
- Naito S, Algaba F, Babjuk M et al: MP9-17 The Clinical Research Office of the Endourology Society (CROES) multicentre randomised trial of narrow band imaging-assisted transurethral resection (TURBT) versus conventional white light-assisted TURBT in primary non-muscle-invasive bladder cancer patients: trial protocol and 1-year results. J Endourol 2015; 29: P1.
- Botteman, Marc F., et al. "The health economics of bladder cancer." Pharmacoeconomics 21.18 (2003): 1315-1330.
- American Cancer Society. Cancer Facts and Figures 2017. https://www.cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures/cancer-facts-figures-2017.html. Accessed May 20, 2018.
- Loras, A., et al. "Bladder cancer recurrence surveillance by urine metabolomics analysis." Scientific reports 8.1 (2018): 9172.
- NCCN Clinical Practice Guidelines in Oncology: Bladder Cancer. Accessed 10/26/18
- Galsky, Matthew D., et al. “Comparative Effectiveness of Treatment Strategies for Bladder Cancer With Clinical Evidence of Regional Lymph Node Involvement.” Journal of Clinical Oncology, vol. 34, no. 22, 2016, pp. 2627–2635.
- Koumpan, Yuri, et al. “Spinal Anesthesia Is Associated with Lower Recurrence Rates after Resection of Nonmuscle Invasive Bladder Cancer.” The Journal of Urology, vol. 199, no. 4, 2017, pp. 940–946.
- Sun, Yanxia, et al. “The Effects of Perioperative Regional Anesthesia and Analgesia on Cancer Recurrence and Survival After Oncology Surgery: A Systematic Review and Meta-Analysis.” Regional Anesthesia and Pain Medicine, vol. 40, no. 5, 2015, pp. 589–598.