Shariat - Figure 45
When to Stop Bladder-sparing Strategy
FIG. 45: Persistence of disease at 3 or 6 months carries a high risk of disease progression. In these patients an early radical cystectomy, despite the absence of muscle-invasive disease, improves survival significantly.[62] BCG-resistant or -refractory disease should prompt radical cystectomy, despite the patient’s not having yet progressed to muscle-invasive disease. Patients who have been treated with BCG with T1 high-grade cancer and who eventually progress to muscle-invasive disease do worse than patients who present with muscle-invasive disease.[63] This is likely because of the longer time latency for them to have micrometastatic disease and disease progression through cancer spread.
References
Solsona E, Iborra I, Dumont R, et al. The 3-month clinical response to intravesical therapy as a predictive factor for progression in patients with high risk superficial bladder cancer. J Urol. 2000;164:685−9 https://doi.org/10.1016/S0022-5347(05)67281-3
Herr HW, Sogani PC. Does early cystectomy improve the survival of patients with high risk superficial bladder tumors? J Urol. 2001;166:1296−9 http://dx.doi.org/10.1016/S0022-5347(05)65756-4
