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Incidence and management of prostatic urethra recurrence in a cohort of 21 patients who received BCG induction for non-muscle invasive bladder cancer.
- Source :
-
Urologic oncology [Urol Oncol] 2024 Sep; Vol. 42 (9), pp. 290.e11-290.e16. Date of Electronic Publication: 2024 Apr 29. - Publication Year :
- 2024
-
Abstract
- Purpose: To describe the incidence and management of patients who develop a prostatic urethral (PU) urothelial carcinoma recurrence after Bacillus Calmette-Guerin (BCG) induction for non-muscle invasive bladder cancer (NMIBC).<br />Materials and Methods: We performed a retrospective cohort study of all patients who received BCG induction at our institution from 1996 to 2021 (N = 642) for NMIBC. All patients with pathologically confirmed PU involvement following BCG induction with no known PU involvement pre-BCG were included. We describe the presentation, management, and outcomes for PU recurrence.<br />Results: Among the 642 patients, 21 (3.3%) patients had a PU recurrence after BCG induction. 8 (38%) patients received >2 cycles of BCG induction prior to the recurrence. Median time from induction to PU recurrence was 21 months and 12 (57.1%) patients had concurrent bladder recurrence. At the time of their PU recurrence, 14/21 (67%) of patients were deemed BCG Unresponsive. Nearly all (18/21) were high grade, and 10 were stage Tis, 7 Ta, and 3 T1, and 1 T2. 19/21 (90%) patients received bladder sparing treatment: 6 with TURBT and BCG, 6 with TURBT and intravesical chemotherapy, 5 with TURBT only, and 2 did not receive immediate treatment of their PU recurrence due to advanced stage of disease. 2/21 (9.5%) received a radical cystectomy for initial treatment of the post-BCG PU recurrence, of which all were >pT2. Median follow-up time from BCG induction to the patient's last visit was 64.5 months. Following treatment of PU recurrence, 15/18 patients had another recurrence at a median of 5 months: about 47% of recurrences were bladder only and 14% recurred only in the PU as well. About 1 patient received a RC after the second recurrence and was pT2.<br />Conclusion: Patients with PU recurrences following intravesical BCG have a high-risk disease phenotype with a significant risk of recurrence. Conservative management may be appropriate for well-selected patients who do not desire a cystoprostatectomy.<br /> (Copyright © 2024 Elsevier Inc. All rights reserved.)
- Subjects :
- Humans
Male
Retrospective Studies
Aged
Middle Aged
Incidence
Prostatic Neoplasms pathology
Prostatic Neoplasms therapy
Neoplasm Invasiveness
Cohort Studies
Urethral Neoplasms therapy
Urethral Neoplasms pathology
Adjuvants, Immunologic therapeutic use
Aged, 80 and over
Carcinoma, Transitional Cell therapy
Carcinoma, Transitional Cell pathology
Non-Muscle Invasive Bladder Neoplasms
Urinary Bladder Neoplasms pathology
Urinary Bladder Neoplasms therapy
BCG Vaccine therapeutic use
BCG Vaccine administration & dosage
Neoplasm Recurrence, Local
Subjects
Details
- Language :
- English
- ISSN :
- 1873-2496
- Volume :
- 42
- Issue :
- 9
- Database :
- MEDLINE
- Journal :
- Urologic oncology
- Publication Type :
- Academic Journal
- Accession number :
- 38688797
- Full Text :
- https://doi.org/10.1016/j.urolonc.2024.04.017