Role of routine transurethral biopsy and isolated upper tract cytology after intravesical treatment of high‐grade non‐muscle invasive bladder cancer

Lightfoot, Andrew J.; Rosevear, Henry; Nepple, Kenneth G.; O’Donnell, Michael A.

doi:10.1111/j.1442-2042.2012.03089.x

Cited by 16 publications

(7 citation statements)

References 15 publications

(55 reference statements)

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“…In order to avoid delays in identifying treatment failures, we pursued repeat evaluation under anesthesia to pathologically confirm treatment response, rather than depending on office evaluation. This approach avoids the ambiguous cystoscopic and cytologic findings that can occur in the early post-inflammatory period after intravesical therapy and identifies failures earlier, both intravesically and extravesically [ 18 ]. While our cohort of Gem/Doce failing patients who proceeded to cystectomy was small, the findings of favorable pathology (no positive surgical margins or lymph node positive disease) and low progression rate (1 of 10 with T4 disease based upon prostatic stromal invasion) suggest that treatment delay to allow a trial of Gem/Doce is oncologically safe.…”

Section: Discussionmentioning

confidence: 99%

“…Surveillance was initiated 12 to 16 weeks after beginning Gem/Doce and involved either an evaluation under anesthesia (formal restaging) or office cystoscopic follow-up. A restaging procedure was offered to all high-grade cases and included cystoscopy, bladder barbotage cytology, bilateral upper tract barbotage cytologies, bilateral retrograde pyelograms, random bladder biopsies, and prostatic urethral biopsies [ 18 ]. If patients refused formal restaging or were considered too high an anesthetic risk, office cystoscopy with bladder cytology was performed with upper tract imaging at least every 2 years.…”

Section: Methodsmentioning

confidence: 99%

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Sequential Intravesical Gemcitabine and Docetaxel for the Salvage Treatment of Non-Muscle Invasive Bladder Cancer

et al. 2015

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Background:Bacillus Calmette-Guerin (BCG) is the most effective intravesical therapy for non-muscle invasive bladder cancer (NMIBC), but patients can fail or supply shortages can develop. For BCG failures, radical cystectomy is recommended. However, in patients who desire bladder preservation or are poor surgical candidates, alternative salvage intravesical therapies should be explored.Objective:To determine whether dual sequential intravesical gemcitabine and docetaxel is effective in treating NMIBC.Methods:We evaluated our initial experience with 45 patients treated with intravesical gemcitabine and docetaxel between June 2009 and May 2014. Patients were treated with 6 weekly instillations of gemcitabine (1 gram of gemcitabine in 50 ml of sterile water) followed immediately by docetaxel (37.5 mg of docetaxel in 50 mL of saline). Treatment success was defined as no bladder cancer recurrence and no cystectomy. Intention-to-treat analysis was performed using the Kaplan Meier method.Results:Forty-five patients received treatment with a median overall follow-up of 15 months. Median follow up for treatment success was 6 months in all patients and 13 months for responders. Five patients were unable to tolerate a full induction course. Treatment success was 66% at first surveillance, 54% at 1 year, and 34% at 2 years after initiating induction. Ten patients received cystectomy (median of 5.6 months from starting induction) with no positive margins or lymph nodes on final pathology.Conclusions: Sequential dual intravesical gemcitabine and docetaxel can salvage some patients in a challenging NMIBC cohort.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Sequential Intravesical Gemcitabine and Docetaxel for the Salvage Treatment of Non-Muscle Invasive Bladder Cancer

et al. 2015

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“…Patients on adjuvant MIBC trials are at risk not only for metastases, but also for recurrent or second primary tumors arising at new locations in the remaining urothelial tract. Diagnostic studies used to detect local urothelial cancer recurrence (Table 3) should be considered and standardized during clinical trial design.…”

Section: Managing New Urothelial Tract Cancersmentioning

confidence: 99%

Eligibility and Radiologic Assessment in Adjuvant Clinical Trials in Bladder Cancer

et al. 2019

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To harmonize eligibility criteria and radiographic disease assessments in clinical trials of adjuvant therapy for muscle-invasive bladder cancer (MIBC).METHODS National experts in bladder cancer clinical trial research, including medical and urologic oncologists, radiologists, biostatisticians, and patient advocates, convened at a public workshop on November 28, 2017, to discuss eligibility, radiographic entry criteria, and assessment of disease recurrence in adjuvant clinical trials in patients with MIBC. RESULTSThe key workshop conclusions for adjuvant MIBC clinical trials included the following points: (1) patients with urothelial carcinoma with divergent histologic differentiation should be allowed to enroll; (2) neoadjuvant chemotherapy is defined as at least 3 cycles of neoadjuvant cisplatin-based combination chemotherapy; (3) patients with muscle-invasive, upper-tract urothelial carcinoma should be included in adjuvant trials of MIBC; (4) patients with severe renal insufficiency can enroll into trials using agents that are not renally excreted;(5) patients with microscopic surgical margins can be included; (6) patients should undergo a standard bilateral lymph node dissection prior to enrollment; (7) computed tomographic (CT) imaging should be performed within 4 weeks prior to enrollment. For patients with renal insufficiency who cannot undergo CT imaging with contrast, noncontrast chest CT and magnetic resonance imaging of the abdomen and pelvis with gadolinium should be done; (8) biopsy of indeterminate lesions to evaluate for malignant disease should be done when feasible; (9) a uniform approach to evaluate indeterminate radiographic lesions when biopsy is not feasible should be included in any trial design; (10) a uniform approach to determining the date of recurrence is important in interpreting adjuvant trial results; and (11) new high-grade, upper-tract primary tumors and new MIBC tumors should be considered recurrence events. CONCLUSIONS AND RELEVANCEA uniform approach to eligibility criteria, definitions of no evidence of disease, and definitions of disease recurrence may lead to more consistent interpretations of adjuvant trial results in MIBC.

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“…In this article, Lightfoot et al . retrospectively reviewed 116 consecutive cases (CIS: 86, T1/high grade: 16, Ta/high grade: 14) at high risk of NMIBC who were treated with adjuvant intravesical instillation therapy by undergoing “restaging” comprising of random bladder biopsy including prostatic urethra in men, washing bladder cytology and upper urinary tract (UUT) cytology 4 . Abnormalities of any type were found in 59 cases (50.9%), out of which 15 (25.4%) had negative cystoscopy and negative bladder cytology, and would have been missed by routine surveillance.…”

mentioning

confidence: 99%

Editorial Comment to Role of routine transurethral biopsy and isolated upper tract cytology after intravesical treatment of high‐grade non‐muscle invasive bladder cancer

Matsuyama¹

2012

Int J of Urology

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Editorial Comment to Role of routine transurethral biopsy and isolated upper tract cytology after intravesical treatment of high-grade non-muscle invasive bladder cancerConcurrent carcinoma in situ of the bladder (CIS) is the strongest predictor for disease progression in non-muscle invasive bladder cancer (NIMBC), thus this factor has been given the highest point in The European Organization for Research and Treatment of Cancer (EORTC) risk.1 Patients in the high-risk group according to the European Association of Urology (EAU) guideline had significantly worse prognosis when patients had concurrent CIS when compared with patients without CIS.1 Hara et al. found CIS in normal-looking mucosa in 24.7% of intermediate-risk and 59.4% of high-risk patients, respectively.2 Such accumulating evidence suggests the important role of concurrent CIS, and prompts urologists to seek the abnormalities even in normal-looking urothelial mucosa. ) at high risk of NMIBC who were treated with adjuvant intravesical instillation therapy by undergoing "restaging" comprising of random bladder biopsy including prostatic urethra in men, washing bladder cytology and upper urinary tract (UUT) cytology. 4 Abnormalities of any type were found in 59 cases (50.9%), out of which 15 (25.4%) had negative cystoscopy and negative bladder cytology, and would have been missed by routine surveillance. Notably, the authors emphasized the importance of biopsy of the prostatic urethra, region of sanctuary for the tumor after Bacille CalmetteGuérin (BCG) therapy, in which seven of nine cases with positive urethral biopsy showed no evidence of malignancy in the bladder. Considering the poor prognosis of urethral involvement with stromal invasion, and a significantly higher prevalence of urethral involvement in concurrent CIS patients, urethral biopsy might be considered for patients with concurrent CIS. As the discrepancy between negative bladder cytology, and positive bladder and/or urethral biopsy has been reported after BCG instillation therapy, 5 random urothelial mucosal biopsy (including prostatic urethra) might be required for the evaluation of BCG therapy. Another important issue might be the higher prevalence (33%; 38/116 cases) of positive cytology in UUT. Of the 38 patients with positive UUT cytology, bladder cytology was negative in 17 patients, out of whom five (29%) later underwent nephroureterectomy. The result strongly suggests routine UUT cytology might be required , even in patients with negative bladder cytology after successful BCG therapy.Who is the candidate for UUT cytology and random urothelial mucosal biopsy? Hara et al. reported a significantly lower frequency of positive bladder cytology in lowrisk patients than that in their intermediate/high-risk counterparts.2 Considering the results of this article and previous studies, the best candidates should be: (i) patients with concurrent CIS or with a history of CIS; (ii) patients with positive urine cytology; and (iii) a second transurethral resection case as a result of a T1/hig...

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Role of routine transurethral biopsy and isolated upper tract cytology after intravesical treatment of high‐grade non‐muscle invasive bladder cancer

Cited by 16 publications

References 15 publications

Sequential Intravesical Gemcitabine and Docetaxel for the Salvage Treatment of Non-Muscle Invasive Bladder Cancer

Sequential Intravesical Gemcitabine and Docetaxel for the Salvage Treatment of Non-Muscle Invasive Bladder Cancer

Eligibility and Radiologic Assessment in Adjuvant Clinical Trials in Bladder Cancer

Editorial Comment to Role of routine transurethral biopsy and isolated upper tract cytology after intravesical treatment of high‐grade non‐muscle invasive bladder cancer

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