Best of AUA 2014: Bladder Cancer
Presented by Wassim Kassouf, MD, CM,
• Both men and women experience significant delays between presentation with microhematuria and bladder cancer diagnosis, but longer delays are seen in women, which may partly explain the gender-based discrepancies published in recent years.
• Risk of urinary tract malignancy in over 7,000 patients with asymptomatic microhematuria was 2.4%—useful information for counseling patients regarding a hematuria workup.
• Screening men aged 60 to 80 years with a smoking history of more than 30 pack-years yielded a bladder cancer incidence rate of 2/1,000 person years.
• In nonmuscle-invasive disease, a study comparing Hexvix transurethral resection of bladder tumor (TURBT) plus mitomycin with white-light TURBT plus mitomycin found no impact on recurrence nor progression in patients undergoing Hexvix TURBT plus mitomycin at 3 years.
• The combination of bacillus Calmette-Guérin (BCG) plus interferon showed significantly lower recurrence rates and significantly less toxicity compared to patients treated with BCG in a randomized, prospective trial.
• Sequential BCG/electromotive mitomycin for high-risk disease showed an 84% complete response rate at 1 year, but 29% of patients did not tolerate the nine-dose full-induction course.
• Upper tract and/or urethral cancer was detected during long-term follow-up in more than 50% of patients with high-risk nonmuscle-invasive disease failing at least two courses of BCG. In the stratification of T1 disease, both the a/b classification and the extensive versus microinvasive stratification were validated to significantly predict progression.
• In invasive bladder cancer, sarcopenia is associated with increased complications, increased mortality, and decreased cancer-specific survival after radical cystectomy, and is prognostic in patients with metastatic disease.
• Neutrophil-to-lymphocyte ratio was an independent prognostic factor in patients treated with radical cystectomies in multiple abstracts.