To review the published data on predisposing risk factors for cancer treatment-induced haemorrhagic cystitis (HC) and the evidence for the different preventive and therapeutic measures that have been used in order to help clinicians optimally define and manage this potentially serious condition.Despite recognition that HC can be a significant complication of cancer treatment, there is currently a lack of UK-led guidelines available on how it should optimally be defined and managed.A systematic literature review was undertaken to evaluate the evidence for preventative measures and treatment options in the management of cancer treatment-induced HC.There is a wide range of reported incidence due to several factors including variability in study design and quality, the type of causal agent, the grading of bleeding, and discrepancies in definition criteria.The most frequently reported causal factors are radiotherapy to the pelvic area, where HC has been reported in up to 20% of patients, and treatment with cyclophosphamide and bacillus Calmette-Guérin, where the incidence has been reported as up to 30%.Mesna (2-mercaptoethane sodium sulphonate), hyperhydration and bladder irrigation have been the most frequently used prophylactic measures to prevent treatment-related cystitis, but are not always effective.Cranberry juice is widely cited as a preventative measure and sodium pentosanpolysulphate as a treatment, although the evidence for both is very limited.The best evidence exists for intravesical hyaluronic acid as an effective preventative and active treatment, and for hyperbaric oxygen as an equally effective treatment option.The lack of robust data and variability in treatment strategies used highlights the need for further research, as well as best practice guidance and consensus on the management of HC.

Background Haemorrhagic cystitis (HC) is most commonly caused by intravenous chemotherapy drugs, notably cyclophosphamide, 1,2 administration of treatments directly into the bladder (e.g. bacillus Calmette-Guérin), 3,4 or radiation therapy to the pelvic area. 5 Cases of HC have also been reported with the use of other therapeutic agents, 2,6-9 recreational drugs 10 and environmental toxins. 11 HC has a spectrum of manifestations that range from non-visible (or microscopic) haematuria to gross (visible) haematuria with clots, 12 and has a reported incidence from less than 10% up to 35%. 4,5,13-15 Severe HC can be a challenging condition to treat and may give rise to serious complications, 16 leading to prolonged hospitalisation and occasional mortality. 12 Several reviews of the available preventive and therapeutic options for chemical-and radiation-induced cystitis

To determine whether needle size influences a patient's perception of pain, 50 patients requiring hormonal manipulation for prostate cancer were blindfolded and randomised to receive two goserelin ('Zoladex') or two leuprorelin ('Prostap') injections, using 16-or 23-gauge needles, respectively. Median visual analogue scale pain scores for the first injections of goserelin and leuprorelin were below the level of clinical significance and were not statistically different. Mean administration time for goserelin was significantly shorter than for leuprorelin. In conclusion, there was no statistically significant difference in pain experienced on injection of goserelin and leuprorelin when patients were unaware of needle size.

Total of 67 patients had pathological T3a disease. Biochemical recurrence was defined as PSA ≥ 0.2. 32 (48%) patients had biochemical recurrence. These patients had salvage treatment at PSA relapse rather than adjuvant. 18 out of 32 patients received radiotherapy before their PSA reached 2 and 1 patient had subcapsular orchidectomy. Overall 3 out of 37 patients had progressive disease (1 lymph node, 2 bone metastases) requiring hormonal treatment. Hence in our study 96% had progression free survival and 100% disease specific survival. 5year biochemical recurrence free survival was 67%. The overall survival was 94%. Conclusions: Surgery alone can be sufficient for pT3a prostate cancer in selected cases. Salvage radiotherapy offers additional advantage to the patients without compromising oncological outcome. Hence, we may offer surgery as a first line of multimodality therapy to all suspected pT3a patients over radiotherapy ± hormones.

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