Abstract
I aimed to investigate the best options for patients with high-grade T1 bladder cancer.
Between 2006 and 2011, 39 patients were diagnosed with high-grade T1 bladder cancer at the King Abdullah Medical City, Makkah, Saudi Arabia. Average follow-up was 60months. Multifocal tumours larger than 2cm were found in 36 (92%) patients. Carcinoma in situ was found in four (10.3%) patients. Residual disease was found in 15 (38.5%) patients.
Seven patients underwent early radical cystectomy and bladder reconstruction (neo-bladder). The remaining 32 patients were treated with intravesical Bacillus Calmette-Guérin (BCG) therapy, except for one patient, who received gemcitabine. During follow-up, 25 (78.1%) of 32 patients developed recurrence, 18 of them without cancer progression and underwent a second BCG course, while seven (21.9%) patients progressed to muscle invasion, and underwent delayed radical cystectomy with neo-bladder. Seven (21.9%) of 32 patients continued on BCG maintenance therapy. In a subgroup of 18 patients, 12 (67%) of 18 patients developed further recurrence and progression, which was treated by deferred radical cystectomy with neo-bladder, except two patients, who were treated with ileal loop conduit, whereas six patients continued with maintenance BCG. 5-year survival rates were reported for six (85.7%) patients in the early cystectomy group and in 12 (63.3%) patients in the deferred cystectomy group, respectively.
Radical cystectomy is an option for patients with high-grade T1 bladder cancer.