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Purpose: Patients with Ta low-grade (LG) nonmuscle-invasive bladder cancer (NMIBC) rarely develop metastases or die of it. Long-term data are scant and length of follow-up poorly defined. Materials and Methods: This retrospective study included 521 patients diagnosed with primary TaLG NMIBC (n = 491) or papillary urothelial neoplasm of low malignant potential (n = 30) from 1989 to 2019 at an academic center. Patient data were acquired using patient records chart review and a bladder cancer informatics registry at the center. Risk of recurrence and progression in stage to muscle invasion, metastases, and death due to bladder cancer (BC) were analyzed. RNAseq assessed the transcriptomic profiles of 4 TaLG NMIBCs that metastasized. Interobserver variability in pathological grading (WHO 2004/2022 and 1973, n = 80) was blindly assessed by 3 expert pathologists. Results: The median follow-up was 9.6 (95% CI: 8.6-10.2) years. Among 521 patients (73% men, median age 67.0 years), 350 recurred, 57 progressed in stage, 20 developed metastases, and 15 died of BC (median 9.6 years after diagnosis). Cancer-specific survival probabilities were 0.99, 0.98, and 0.96 at 5, 10, and 15 years, respectively. Fifty patients who were recurrence free for the first 5 years developed late recurrences and 2 of them died of BC. Metastatic TaLG NMIBC had more adverse transcriptomic findings in keeping with higher-grade tumors despite being phenotypically similar to indolent tumors. Grading concordance for the 2004/2022 system and WHO 1973 was 0.78 (95% CI: 0.65-0.90) and 0.41 (95% CI: 0.32-0.50), respectively. Conclusions: This study with long-term data challenges the assumption that primary TaLG NMIBC nearly never progresses to lethal disease if followed long enough. However, the risk of BC-related mortality is extremely low in patients who are recurrence free for the first 5 years. Minimizing variability in pathological grading remains an unmet need. [ABSTRACT FROM AUTHOR]

ContextProstate cancer (PCa) remains an increasingly common malignancy worldwide. The optimal management of clinically localized, early-stage disease remains unknown, and profound quality of life issues surround PCa interventions.ObjectiveTo systematically summarize the current literature on the management of low-risk PCa with active surveillance (AS), with a focus on patient selection, outcomes, and future research needs.Evidence acquisitionA comprehensive search of the PubMed and Embase databases from 1980 to 2011 was performed to identify studies pertaining to AS for PCa. The search terms used included prostate cancer and active surveillance or conservative management or watchful waiting or expectant management. Selected studies for outcomes analysis had to provide a comprehensive description of entry characteristics, criteria for surveillance, and indicators for further intervention.Evidence synthesisData from seven large AS series were reviewed. Inclusion criteria for surveillance vary among studies, and eligibility therefore varies considerably (4-82%). PCa-specific mortality remains low (0-1%), with the longest published median follow-up being 6.8 yr. Up to one-third of patients receive secondary therapy after a median of about 2.5 yr of surveillance. Surveillance protocols and triggers for intervention vary among institutions. Most patients are treated for histologic reclassification (27-100%) or prostate-specific antigen doubling time

ContextProstate cancer (PCa) remains an increasingly common malignancy worldwide. The optimal management of clinically localized, early-stage disease remains unknown, and profound quality of life issues surround PCa interventions.ObjectiveTo systematically summarize the current literature on the management of low-risk PCa with active surveillance (AS), with a focus on patient selection, outcomes, and future research needs.Evidence acquisitionA comprehensive search of the PubMed and Embase databases from 1980 to 2011 was performed to identify studies pertaining to AS for PCa. The search terms used included prostate cancer and active surveillance or conservative management or watchful waiting or expectant management. Selected studies for outcomes analysis had to provide a comprehensive description of entry characteristics, criteria for surveillance, and indicators for further intervention.Evidence synthesisData from seven large AS series were reviewed. Inclusion criteria for surveillance vary among studies, and eligibility therefore varies considerably (4-82%). PCa-specific mortality remains low (0-1%), with the longest published median follow-up being 6.8 yr. Up to one-third of patients receive secondary therapy after a median of about 2.5 yr of surveillance. Surveillance protocols and triggers for intervention vary among institutions. Most patients are treated for histologic reclassification (27-100%) or prostate-specific antigen doubling time

Objectives: To assess whether office‐based fulguration (OF) under local anaesthesia for small, recurrent, pathological Ta low‐grade (LG) non‐muscle‐invasive bladder cancer (NMIBC) is an effective alternative to transurethral resection of bladder tumour (TURBT), avoiding the costs and risks of procedure, and anesthesia. Patients and Methods: Of 521 patients with primary TaLG NMIBC, this retrospective study included 270 patients who underwent OF during follow‐up for recurrent, small, papillary LG‐appearing tumours at a university centre (University Health Network, University of Toronto, Canada). We assessed the cumulative incidence of cancer‐specific mortality (CSM) and disease progression (to MIBC or metastases), as well as possible direct cost savings. Results: In the 270 patients with recurrent TaLG NMIBC treated with OF, the mean (sd) age was 64.9 (13.3) years, 70.8% were men, and 60.3% had single tumours. The mean (sd, range) number of OF procedures per patient was 3.1 (3.2, 1–22). The median (interquartile range) follow‐up was 10.1 (5.8–16.2) years. Patients also underwent a mean (sd) of 3.6 (3.0) TURBTs during follow‐up in case of numerous or bulkier recurrence. In all, 44.4% of patients never received intravesical therapy. The 10‐year incidence of CSM and progression were 0% and 3.1% (95% confidence interval 0.8–5.4%), respectively. Direct cost savings in Ontario were estimated at $6994.14 (Canadian dollars) per patient over the study follow‐up. Conclusions: This study supports that properly selected patients with recurrent, apparent TaLG NMIBC can be safely managed with OF under local anaesthesia with occasional TURBT for larger or numerous recurrent tumours, without compromising long‐term oncological outcomes. This approach could generate substantial cost‐saving to healthcare systems, is patient‐friendly, and could be adopted more widely. [ABSTRACT FROM AUTHOR]

This article explores the advancements and changes in the field of urology, specifically focusing on prostate and kidney cancers. The author, Mark Soloway, shares his experiences and observations throughout his career, highlighting the introduction of new techniques such as transrectal ultrasound of the prostate (TRUS) for biopsies and periprostatic nerve blocks to reduce discomfort. The article also discusses the shift towards active surveillance for low-risk prostate cancer and the development of hormonal therapies for prostate cancer. Soloway emphasizes the importance of a multidisciplinary approach and ongoing research in making treatment decisions. Additionally, the author briefly mentions their experience with surgical techniques for removing large renal tumors involving the renal vein and vena cava. [Extracted from the article]