FEASIBILITY OF TRANSURETHRAL RESECTION FOR MUSCLE INFILTRATING CARCINOMA OF THE BLADDER - LONG-TERM FOLLOW-UP OF A PROSPECTIVE-STUDY

Purpose: We analyzed the long-term results of radical transurethral re section for the treatment of a large series of patients with muscle in filtrating bladder cancer entered into a prospective study to determin e progression predictive factors. Materials and Methods: The study inc luded 133 patients with invasive bladder cancer treated by radical tra nsurethral resection who had negative biopsies of the muscle layer of the tumor bed. Followup was more than 5 years for all subjects and mor e than 10 years in 59 (44.4%). A comparative nonrandomized study was p erformed of a control group of 76 patients with invasive pathological stage pT2-3a, NO-3 bladder cancer treated by cystectomy. In those pati ents treated by radical transurethral resection univariate and multiva riate analyses were performed to establish clinical progression predic tive factors. Results: At 5 and 10 years of followup cause specific su rvival rates were 80.5 and 74.5%, and bladder preservation rates were 82.7 and 79.6%, respectively. No significant difference was noted in t erms of cause specific survival, with respect to the control group. Th e initial presence of associated bladder carcinoma in situ was the onl y independent progression predictive factor. Conclusions: For patients with invasive bladder cancer radical transurethral resection is justi fied when the tumor is clinically limited to the muscular layer and wh en all biopsies of the periphery and depth of the tumor bed show muscu lar tissue negative for tumor cells. Patients with initial associated bladder carcinoma in situ should not be excluded from this treatment b ut endovesical bacillus Calmette-Guerin immunotherapy should be admini stered and a closer followup is recommended.