Superficial Bladder Tumours: Recurrence and Progression

Objective: To determine various presentations of superficial bladder cancer, its management, recurrence and progression rates. Study Design: Case series. Place and Duration of Study: Department of Urology, Jinnah Postgraduate Medical Centre, Karachi, from January 2002 to December 2009. Methodology: Patients with pathologically proven superficial transitional cell carcinoma (TCC) with minimal 2 years of follow-up were included. Their clinical presentations and management was recorded. Complete transurethral resection of bladder tumour (TURBT) was attempted in all patients. Tumour grading and staging was performed. Intra-vesical single instillation of Mitomycin-C was given postoperatively in selected patients. Cystoscopic surveillance was used to assess recurrence in all patients according to standard protocol. Metastatic work-up and biopsy record of follow-up TURBT was used to document progression in high risk patients. Results were described as simple descriptive statistics. Results: A total of 92 patients were studied. The median age of patient was 62 years, with male preponderance (88%). Hematuria with lower urinary tract symptoms (LUTS) was most common presentation (47.8%), followed by hematuria alone (25.7%), LUTS alone (9.2%) and upper tract symptom in 1.8% of patients. Complete TURBT in first attempt was possible in 72 patients (78.3%). Multiple tumours were seen in 34 patients (39.6%). Intravesical mitomycin was given in 70% patients. Over-all recurrence rate of 68.4% was noted. Patients with TaG2-3 showed recurrence rate of 58.8% which occurred late with good recurrence free interval. T1G2-3 patients have more and early recurrences (80.4%). Progression seen in 13 patients (14%), 6 patients have up-grading, four showed stage progression, one developed pelvic lymphadenopathy and another one had bone metastasis. One female patient (TaG2) developed right renal pelvic recurrence and progression while her bladder disease was well controlled. Conclusion: The number of patients with T1 disease was 45% in this study which is comparatively higher than other studies. Early recurrences and progression were observed with T1G2-3, while late recurrence were seen with Ta disease, having tumour free interval between 6 months to 2 years. Early radical cystectomy was advised to T1G3 disease and with multiple recurrences, but patient's compliance was poor.