Transitional cell carcinoma of the bladder in young adults: presentation, natural history and outcome.

Purpose: The natural history and prognosis of bladder cancer in young patients is not well defined. We analyzed our experience with such patients.
Materials and Methods: The medical records of 74 patients presenting with transitional cell carcinoma of the bladder at 40 years and younger were reviewed and compared with those of 75 patients diagnosed with bladder transitional cell carcinoma at 65 years old and older.
Results: Median followup was 28.1 months (range 1 to 155) and 34.7 (range 1 to 178) in young and old patients, respectively. Initial stage distribution was similar with 80% of patients presenting with superficial disease. No difference was observed in the disease-free progression or disease-free recurrence rate among the groups in patients initially presenting with stage Ta, Tis or T1 tumors. A significantly higher proportion of older versus younger patients underwent cystectomy (54% versus 23%). We did not observe a difference in pathological stage distribution or the rate of extravesical disease in young and old patients (47% and 45%, respectively). Younger patients who ultimately underwent radical cystectomy had significantly lower disease-free survival, mainly due to a higher rate of distant metastases than in the older group (41% versus 24%). The rate of local recurrence was similar.
Conclusions: Bladder transitional cell carcinoma in young adults has a clinical stage distribution and natural history similar to that in older patients. Our study suggests that a subset of young patients who ultimately undergo radical cystectomy have particularly aggressive tumors, portending a poor outcome.