A 63-year-old otherwise healthy male is referred for evaluation of hematuria. A computed tomography urogram reveals a tumor on left lateral wall. The patient undergoes a transurethral resection of bladder tumor (TURBT) that demonstrates high-grade urothelial carcinoma with invasion of the lamina propria (T1). Muscularis propria is present and is uninvolved. Random bladder biopsies at the time of transurethral resection demonstrate normal mucosa.
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Patients with urothelial carcinoma of the bladder that penetrate into the lamina propria (T1) are faced with a unique set of challenges. Understaging of such tumors is a great and primary concern,1 especially if no muscle is present in the original transurethral resection specimen. Even if muscularis propria is present in the original specimen, such as in this case, re-resection (i.e., 2nd TURBT approximately four weeks following initial resection) is currently the standard of care for patients with T1 disease.2
Data show that at re-resection 45%-75% of patients will exhibit residual tumor cells, while 30%-40% will be upstaged to muscle-invasive disease. Repeat resection may also serve a prognostic purpose, since those that have residual tumor on re-resection have a much higher rate of disease progression than patients in whom no residual cancer is found (76% vs. 14%).1-3
The case was prepared by Alexander Kutikov, MD, of Fox Chase Cancer Center in Philadelphia.
- Fritsche HM, Burger M, Svatek RS, et al. Characteristics and outcomes of patients with clinical T1 grade 3 urothelial carcinoma treated with radical cystectomy: results from an international cohort. Eur Urol 2010;57:300-309.
- Brausi M, Witjes JA, Lamm D, et al. A review of current guidelines and best practice recommendations for the management of nonmuscle invasive bladder cancer by the International Bladder Cancer Group. J Urol 2011;186:2158-2167.
- Nepple KG, O’Donnell MA. The optimal management of T1 high-grade bladder cancer. Can Urol Assoc J 2009;3: S188-S192.