MULTIPLE FREQUENT RECURRENCES IN SUPERFICIAL TRANSITIONAL-CELL CARCINOMA OF THE BLADDER - IS SURVIVAL COMPROMISED BY A CONSERVATIVE MANAGEMENT STRATEGY

Objective To examine whether a strategy of bladder conservation is rea sonable in patients with multiple frequent superficial recurrences of transitional cell carcinoma (TCC) of the bladder. Patients and methods Fifty-four patients with pTa/pT1, G1/G2 tumours at diagnosis, with fi ve or more recurrences at two or more cystoscopies within 2 years of d iagnosis and a minimum follow-up of 4 years were identified. The patie nts were categorized according to outcome, i.e. disease settled, conti nuing high-activity disease and disease progression. Results Forty-fou r patients did not progress, of whom 16 continued to have high-activit y disease and 28 settled to a lower disease activity. One patient had a cystectomy for superficial disease. Nine patients progressed, six wi th muscle invasion in the bladder and three elsewhere in the urinary t ract. Neither grade nor stage were predictive of recurrence. All but o ne of the patients with progression had both multicentric tumours at d iagnosis and a positive cystoscopy at 3 months. Three patients died fr om their bladder cancer. Conclusion A policy of endoscopic resections and intravesical chemotherapy or bacille-Calmette-Guerin, with cystect omy reserved until muscle-invasive disease develops, does not signific antly compromise survival in patients with high-activity superficial T CC. Cystectomy for superficial disease is rarely necessary.