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PubMed1998

Bropirimine, an orally active anticancer agent for superficial bladder cancer.

OBJECTIVE: To investigate efficacy and safety of bropirimine, a new orally active interferon inducer, in patients with superficial bladder cancer. METHODS: Twenty patients with histologically confirmed recurrent superficial transitional cell carcinoma (Ta or T1) were studied. At least one marker lesion remained in all patients after transurethral resection. Bropirimine (750 mg) was given orally three times at 2-hour intervals (daily dose 2,250 mg) on 3 consecutive days weekly for 12 weeks. RESULTS: Of the 17 evaluable patients, 1 did not complete the treatment protocol. There were 5 responders, including 2 with a complete response (complete disappearance of the marker tumor) and 3 with a partial response (>50% reduction of the marker tumor). The objective response rate was 31.3% (5/16; 95% confidence interval 11.0-58.7%) for the 16 patients completing treatment and 29.4% (5/17; 95% confidence interval 10.3-56.0%) for the 17 evaluable patients. Adverse reactions occurred in 70.6% of the evaluable patients. Flu-like symptoms were most common, including malaise (23.5%), headache (23.5), and fever (11.8%), followed by gastrointestinal symptoms including less of appetite (23.5%). All of these reactions were tolerable. CONCLUSIONS: Bropirimine may be useful for the prophylaxis of recurrence following transurethral resection of superficial bladder cancer because it shows efficacy against marker tumors and has a good safety profile and oral activity.

Administration, Oral↗

PubMed1991

[A case of bladder transitional cell carcinoma with sigmoidovesical fistula due to diverticulitis].

We present a case of bladder transitional cell carcinoma with sigmoidovesical fistula due to diverticulitis. The patient was a 65-year-old male who had been suffering from recurrent abdominal pain with high fever for the past 6 months. He noticed pneumaturia and cloudy urine several times. He visited a doctor complaining of macroscopic hematuria and high fever, and was treated under the diagnosis of acute prostatitis. In our University Hospital cystoscopy showed a papillary bladder tumor. Pathological study of the tumor revealed transitional cell carcinoma, grade II, noninvasive type. Multiple diverticulosis of sigmoid colon was identified with barium enema examination. We performed transurethral resection of the bladder tumor. Three weeks later, the sigmoidovesical fistula was treated by primary resection of the sigmoid colon and wedge resection of the bladder including fistula.

Aged↗

PubMed2006

A case of T2 muscle-invasive bladder cancer treated with neoadjuvant chemotherapy.

BACKGROUND: A 61-year-old woman with a substantial history of smoking presented with gross hematuria. Cystoscopic evaluation revealed a large bladder tumor. INVESTIGATIONS: Cystoscopic evaluation, histological examination, crosssectional imaging. DIAGNOSIS: High-grade muscle-invasive transitional cell carcinoma (clinical stage T2N0M0, later confirmed as pathologic stage T3aN0M0). MANAGEMENT: Transurethral resection of the bladder tumor, clinical trialbased neoadjuvant treatment with paclitaxel, carboplatin and gemcitabine, and radical cystectomy.

Carcinoma, Transitional Cell↗

PubMed2006

Genitourinary small cell carcinoma: a retrospective review of treatment and survival patterns at The Ottawa Hospital Regional Cancer Center.

OBJECTIVE: To review patients with genitourinary (GU) small cell carcinoma (SCC) treated at a regional cancer centre, as due to its rarity and aggressive nature, GU SCC remains a therapeutic challenge. PATIENTS AND METHODS: The charts of patients managed at a regional cancer centre between 1991 and 2002 for any GU diagnosis were manually reviewed to identify GU SCC. Demographic, staging, treatment and outcome data were extracted. The Veterans Administration small cell lung cancer staging classification of "limited" or "extensive" disease was adapted for SCC of the prostate and bladder (with "limited" defined as disease localized to the true and false pelvis, and "extensive" as disease beyond the pelvis). RESULTS: In all, 555, 858 and 5066 new cases of primary renal, bladder and prostate cancer, respectively, were identified. Of these patients, 22 had GU SCC (12 bladder and 10 prostate; there were no cases of SCC of the kidney). Eight of 12 patients with bladder SCC had limited disease; five of 12 are alive (all with limited disease at diagnosis), and the median survival was 19.8 months. Surviving patients received similar therapy, with transurethral resection of the bladder tumour, platinum-based chemotherapy, etoposide (4-6 cycles), and radical radiotherapy (56-60 Gy). Two of 10 patients with SCC of the prostate had limited-stage disease, but all 10 died, the median survival being 9.5 months. Survival by stage for both types combined was 59 months for limited disease and 8 months for extensive disease. CONCLUSIONS: These results indicate that GU SCC is an aggressive cancer; limited-stage SCC of the bladder or prostate, when treated with platinum/etoposide chemotherapy and radical radiotherapy, has a more favourable outcome than that of extensive GU SCC.

Adult↗

PubMed2000

[A case of neuroendocrine tumor of the urinary bladder].

We present a case of a neuroendocrine tumor of the urinary bladder. A 81-year-old-man presented with macrohematuria and difficult voiding. Cystoscopy, computed tomography (CT) and magnetic resonance imaging (MRI) revealed non-papillary broad-based bladder tumor, benign prostatic hyperplasia and three bladder stones. Histological diagnosis was neuroendocrine tumor of the urinary bladder and he underwent two courses of trans-arterial infusion (neoadjuvant) chemotherapy. After two courses of chemotherapy, pelvic CT scan revealed partial response and then the patient underwent transurethral resection of the bladder tumor, simultaneously with TUR-P and cystolithotripsy. Examination of the resected specimen indicated pathological complete remission and he discharged. Although the patient was followed-up postoperatively because of pathological complete response, the tumor recurred in the bladder three months later.

Aged↗

PubMed2005

Endoscopic therapy of superficial bladder cancer in high-risk patients: Holmium laser versus transurethral resection.

Many lasers are widely used in urological surgery for several applications. Their use to treat the superficial bladder cancer (SBC) is safe and minimally invasive. The Holmium:YAG (Ho:YAG) laser represents the pinnacle of laser technology in Urology. The authors carried out this study on safety, efficacy, complication rates, postoperative catheterization time, and hospital stay of high-risk patients who underwent Ho:YAG vs. transurethral resection (TUR). Two groups of high-risk patients with SBC and comorbidities underwent either Ho:YAG or TUR. Different clinical aspects of the tumours and recurrences were considered. No significant difference between the two groups was noted regarding number, progression of grade and stage and place and time of recurrences. In the Ho:YAG patients, perioperative complications occurred at a lower percent than in the TUR group. Also, in 54% of patients, the catheter was removed within 24 hours; 76% had a postoperative hospital stay of 24 to 48 hours. In the TUR patients: 4% had the catheter removed within 24 hours and 6% left the hospital within 24 to 48 hours. In SBC treatment, Ho:YAG and TUR were equally as effective; the Ho:YAG laser was associated with shorter catheterization time and hospital stay. These Ho:YAG features could be advantageous from a psychological standpoint, particularly for elderly, high-risk patients and in terms of cost:benefit ratios.

Aged↗

PubMed2002

Selective bladder preservation by combined modality protocol treatment: long-term outcomes of 190 patients with invasive bladder cancer.

OBJECTIVES: To evaluate the outcomes of patients with muscle-invasive Stage T2-4a bladder carcinoma managed by transurethral surgery and concurrent chemoradiation. METHODS: A total of 190 patients were treated on institutional prospective protocols using concurrent cisplatin-containing chemotherapy and radiotherapy after rigorous transurethral resection of the bladder tumor. Patients were re-evaluated by repeated biopsy and urine cytologic analysis after 40 Gy, with the initial tumor response guiding subsequent therapy. One hundred twenty-one patients with a complete response by cytologic and histologic examination and those medically unfit for cystectomy received boost chemoradiation to 64 to 65 Gy. Those patients without a complete response were advised to undergo radical cystectomy. A total of 66 patients (35%) ultimately underwent radical cystectomy; 41 for less than a complete response and an additional 25 for recurrent invasive tumors. The median follow-up was 6.7 years for all surviving patients. RESULTS: The 5 and 10-year actuarial overall survival rate was 54% and 36%, respectively (Stage T2, 62% and 41%; Stage T3-T4a, 47% and 31%, respectively). The 5 and 10-year disease-specific survival rate was 63% and 59% (Stage T2, 74% and 66%; Stage T3-T4a, 53% and 52%), respectively. The 5 and 10-year disease-specific survival rate for patients with an intact bladder was 46% and 45% (Stage T2, 57% and 50%; Stage T3-T4a, 35% and 34%), respectively. The pelvic failure rate was 8.4%. No patient required cystectomy because of bladder morbidity. CONCLUSIONS: The 10-year overall survival and disease-specific survival rates are comparable with the results reported for contemporary radical cystectomy for patients of similar clinical and pathologic stage. One third of patients treated on protocol with the goal of bladder sparing ultimately required a cystectomy. A trimodality approach with bladder preservation based on the initial tumor response is, therefore, safe, with most long-term survivors retaining functional bladders.

Actuarial Analysis↗

PubMed1986

Coincident vesical transitional cell carcinoma and prostatic carcinoma. Clinical features and treatment.

Twenty-two patients with vesical urothelial carcinoma associated with prostatic carcinoma were reviewed. They represented 1.5% of the bladder and prostatic tumours treated in our department within a 12-year period from 1968 to 1979. Their management included several treatment policies, based on the separate assessment of each tumour variant. For non-infiltrating bladder tumours, transurethral tumour resection was combined with hormonal treatment, external radiotherapy or resection of the prostate depending on the stage of the prostatic tumour. Radical cystoprostatectomy was performed for two cases of infiltrating bladder tumour with well localised prostatic tumours. A conservative primary approach seems justifiable in the management of double carcinoma of the bladder and prostate. The coincidence of bladder urothelial carcinoma and prostatic carcinoma per se is not an adverse prognostic factor; prognosis is more closely related to the pathological stage and grade of the bladder tumour. Cystoprostatectomy for patients with infiltrating bladder tumours could be curative, in selected cases, for the prostatic cancer as well.

Aged↗

PubMed1994

[Clinical statistics on patients operated at the Department of Urology, Kaizuka Municipal Hospital during ten years (from 1983 to 1993)].

A statistic survey was made on the patients undergoing operations between July, 1983 and June, 1993. The total number of patients was 1780, comprising 1469 males and 311 females. The most frequent organ was the prostate with 526 cases (29.6%), followed by 415 (23.3%) penile and scrotum cases, and 290 (16.3%) bladder cases. Major operations were transurethral resection of prostate (418 cases) and bladder tumor (191 cases).

Adult↗

PubMed2001

[Minimally invasive therapy for bladder and prostate cancer].

Recently, minimally invasive therapy has been a key word in the medical field. Many new therapies have been developed in the field of urology. In this area, bacillus Calmette-Guerin (BCG) instillation therapy, transurethral resection of the bladder tumor and intra-arterial infusion with irradiation therapy are noted as minimally invasive therapies for bladder cancer. Laparoscopic prostatectomy, brachytherapy, three-dimensional conformal radiotherapy (3D-CRT) and high-intensity focused ultrasound (HIFU) have also been developed as minimally invasive therapies for prostate cancer. Though the establishment of the validity of each treatment will still take time, the best treatment for each patient should be chosen case by case, including considerations of postoperative quality of life and economic efficiency.

Administration, Intravesical↗

PubMed1998

Effects of transurethral prostate resection and transurethral laser prostatectomy on plasma hormone levels.

OBJECTIVE: The short and long-term effects of two common transurethral procedures (TURP and TULP, transurethral prostatic resection and laser prostatectomy, respectively) on plasma hormone levels in patients with benign prostatic hyperplasia (BPH) have been evaluated. PATIENTS AND METHODS: Totally 57 patients with histologically proven BPH (age range 54-81 years, mean 62.5 years) were included into the study program. Of these 57 patients, 44 underwent TURP and 13 underwent TULP for treatment of their bladder outlet obstructions. 20 patients with bladder cancer undergoing transurethral resection (n = 15) and those undergoing transurethral laser ablation (n = 5) constituted the control group. Plasma luteinizing hormone (LH), prolactin (PRL), follicle-stimulating hormone (FSH), adrenocorticotrophic hormone (ACTH), cortisol, aldosterone, dihydroepiandrosterone sulfate (DHEA-S) and testosterone levels were assessed in all patients before and after 3 weeks and 3 months following the aforementioned procedures. Comparative evaluation of the results with respect to the effect of different procedures have been made between study and control groups. RESULTS: Preoperatively, we were not able to demonstrate any significant difference with respect to all but plasma prolactin levels (p < 0.05) between the study and control groups. Prolactin levels were found to be significantly higher in BPH patients. In BPH patients undergoing TURP, while LH levels were significantly higher during the 3 weeks' evaluation (p < 0.001) no significant difference could be shown during the 3 months' examination (p > 0.05). Again, prolactin levels did significantly decline (p < 0.05) in patients undergoing TURP during the 3 weeks' follow-up evaluation, no difference was present 3 months postprocedure. On the other hand, in patients undergoing TULP, while we were not able to show any significant difference with respect to plasma prolactin levels (p > 0.05) pre- and postoperatively, plasma LH levels were significantly increased during the 3-month evaluation (p < 0.05). CONCLUSIONS: Alterations in the plasma levels of LH and prolactin following prostatectomy during follow-up evaluation, led the physicians to consider possible effects of some factors released from resected prostate gland. Behavior of prolactin and LH after TURP and laser ablation is quite different in our study. It may be related to the higher amount of residual prostate tissue after TULP. On the other hand, normalization of hormone levels 3 months following TURP, led us to think about the activation of some factors responsible for hormonal regulation which in turn institutes a new hormonal balance.

Adrenocorticotropic Hormone↗

PubMed2003

Leiomyosarcoma of urinary bladder following cyclophosphamide therapy: report of two cases.

Leiomyosarcoma of urinary bladder is rare, although it is the most common mesenchymal tumor in adults. We report two cases of this tumor following cyclophosphamide therapy. The first case is from a 53-year-old man with Wegener's granulomatosis treated for 6 years with cyclophosphamide. He presented with painless hematuria, and the initial biopsy of the bladder tumor revealed a malignant spindle cell neoplasm. A final diagnosis of leiomyosarcoma was made on radical cystoprostatectomy. The second example is from a 21-year-old man who had received cyclophosphamide in early infancy for a bilateral retinoblastoma. He also presented with painless hematuria, and a bladder tumor was resected transurethrally and diagnosed as leiomyosarcoma. He underwent partial cystectomy two months later. Cyclophosphamide, when used for a neoplastic or non-neoplastic condition, is associated with an increased risk of developing bladder cancer. The distribution of histologic subtypes differs from that seen in spontaneous bladder tumors. A review of the literature shows an increased proportion of squamous cell carcinomas and sarcomas, especially leiomyosarcomas in cyclophosphamide exposed patients. Acrolein, a cytotoxic metabolite of cyclophosphamide excreted in urine, is regarded as the most likely causative agent.

Adult↗

PubMed1996

[Clinical studies of inverted papilloma of the bladder].

Clinical studies were conducted on 9 cases of inverted papilloma of the urinary bladder which were transurethrally resected between August, 1987 and July, 1995 at our hospital, in males between 29 and 81 years of age (mean:58.3). Six of the 9 inverted papillomas were localized at the bladder neck and 3 in the trigone. Cystoscopic examinations revealed that inverted papillomas were divided into two types, one with a thick and short stalk with a smooth surface and the other with a thin and long stalk with/without a partial papillary surface. The majority of the former was located in the trigone and all of the latter cases in the bladder neck, suggesting that the two types occurred at different sites. Pathological examination by Hematoxylin-Eosin staining demonstrated that 5 of the 9 cases were of the trabecular type and 4 were of the grandlar type. Immunohistochemically, none of the tumors were stained with the antiprostatic-specific-antigen antibody revealed. Follow-up periods after the operation were from 12 to 48 months(mean:26.6 months) and no recurrence was observed.

Adult↗

PubMed2002

Intravesical adjuvant chemotherapy for superficial transitional cell bladder carcinoma: results of a randomized trial with epirubicin comparing short-term versus long-term maintenance treatment.

PURPOSE: Intravesical instillation of epirubicin (EPI) is one of the most effective adjuvant therapies for non-muscle-invasive bladder cancer after transurethral resection. We evaluated the optimal duration of EPI instillation in a multi-institution prospective randomized clinical study. METHODS: Between June 1995 and May 1998, a total of 125 patients with superficial bladder cancer (transitional cell carcinoma grade 1 or 2) were enrolled in this study, and 102 patients were fully evaluated for recurrence. Two protocols for intravesical therapy (arm A - 30 mg EPI/30 ml saline 19 times over 1 year; arm B - 30 mg EPI/30 ml 12 times over 5 months) were established. Instillations were given every week for 4 weeks and then every 2 weeks for 4 months in arm B. After 5 months of treatment, maintenance was performed with seven further instillations (one every month for 7 months) in arm A. The analyzed background factors were the therapeutic method, gender, history (primary or recurrent tumor), stage (T classification), grade, number of tumors, and tumor size. RESULTS: There were no significant differences in the analyzed background factors between the two arms, and there were no serious side effects in the study. In an intent-to-treat analysis, the overall 3-year recurrence-free survival rates were 48.5% in arm A and 55.1% in arm B. The difference between the two groups was not significant. CONCLUSIONS: This analysis indicated that extended prophylactic maintenance instillation of EPI was not significantly effective in reducing bladder cancer recurrence.

Administration, Intravesical↗

PubMed1997

[A case of paraganglioma of urinary bladder in a 96-year-old female].

A 96-year-old woman was referred to our hospital with gross hematuria. Cystoscopy, computed tomography and magnetic resonance imaging revealed a submucosal bladder tumor. Incomplete transurethral resection was performed with no intraoperative complications. The histopathological diagnosis of nonmalignant paraganglioma was confirmed by immunohistochemical staining. This patient is the oldest of the 49 patients with paraganglioma of the urinary bladder reported in the Japanese literature.

Aged↗

PubMedDate not supplied

Predictive factors for outcome in invasive bladder cancer treated with alternating chemoradiotherapy.

PURPOSE: In order to select patients properly for a bladder preservation program, this retrospective study aimed to evaluate the predictive role of pretreatment- and treatment-related factors in a group of patients with invasive bladder cancer treated with alternating chemoradiotherapy at a single institution. METHODS AND MATERIALS: From 1986 to 1994, 72 patients with invasive bladder cancer, stages T1 poorly differentiated or T2-4M0 refusing surgery or not eligible for surgery, were treated with alternating chemoradiotherapy. Each patient had a pretreatment cystoscopy with an attempted complete transurethral resection of the bladder tumor (TURB). The treatment schedule consisted of chemotherapy (cisplatin, 5-fluorouracil, or methotrexate) alternated with radiotherapy. Over the years, the treatment schedule was modified with respect to the total number of chemotherapy cycles, the type of chemotherapy drugs, the dose per fraction and total dose of radiation therapy, and the presence of a planned treatment gap at midtreatment. Treatments were aligned in order of their received average relative dose intensities of both chemotherapy (ARDICT) and radiotherapy (RDIRT). RESULTS: Twenty-two patients (76%) developed infiltrative bladder recurrences for an estimated 5-year pelvic control rate of 68% +/- 6%; 5-year actuarial survival with intact bladder is 40% +/- 6%. Obstructive uropathy at diagnosis, residual disease after TURB, and ARDICT value equal or below the median were independent predictive factors for pelvic failure, with hazard ratios of 2.87 (95% confidence interval [CI], 1.16-7.04), 8.13 (95% CI, 2.74-24.1), and 3.36 (95% CI, 1.29-8.74), respectively. A more detailed model including interactions among these factors showed that the negative prognostic effect of obstructive uropathy at diagnosis was not modified by ARDICT or TURB resection; on the contrary, the risk of local failure for patients with incomplete TURB was markedly affected by different levels of ARDICT. Also, a trend toward a better local outcome was observed for patients with RDIRT above the median. Hydronephrosis and incomplete TURB were also independent predictors of distant metastases and overall survival, but no effect was found for ARDICT on these endpoints. DISCUSSION: As a result of this analysis we believe that (1) patients with obstructive uropathy should not be offered a bladder-sparing approach, (2) gross total TURB of the primary tumor should be maximized, (3) prompt surgery should be considered for patients with incomplete TURB who are not compliant with the combined-modality treatment, and (4) the intrinsic value of dose intensity of both chemotherapy and radiotherapy should be confirmed in a prospective, controlled study.

Adult↗

PubMedDate not supplied

[Nephrureterectomy with endoscopic resection of the urinary bladder, ureteral ostium and terminal part in papillary tumors of the upper urinary tracts].

Short- and long-term results of endoscopically assisted nephrureterectomy were studied in 15 patients (7 males and 8 females aged 31-79 years) with papillary tumours of the upper urinary tracts (UUT). Of them, 11 patients have undergone transurethral endoresection of the urinary bladder, ostium and terminal part of the ipsilateral ureter followed by nephrureterectomy from the lumbotomic approach (technique 1) and 4 patients had nephrureterectomy followed by endoscopic intervention (technique 2). Results of standard open nephrureterectomy with resection of the bladder were analyzed retrospectively for 25 patients with papillary tumors of the UUT taken as control. It was found that transurethral endoscopic resection of the bladder, ostium and terminal part of the ipsilateral ureter in nephrureterectomy for papillary tumors of the UUT facilitates the performance, decreases duration and aggression of surgical intervention, diminishes number of complications, shortens hospital stay of the patients and their rehabilitation. Technique 1 is thought more ablastic and simple in performance.

Adult↗

PubMedDate not supplied

Treatment strategies using transurethral surgery, chemotherapy, and radiation therapy with selection that safely allows bladder conservation for invasive bladder cancer.

Combined modality therapy with the goal of effecting cure and achieving organ preservation has become the standard oncological approach in many malignancies. Although radical cystectomy has been considered the standard treatment for invasive carcinoma of the bladder, equivalent results have been achieved using combined modality treatment in selected patients, particularly those with T2 and T3a disease without obstructed ureters. Effective combined modality treatment consists of three treatment modalities: (1) transurethral resection of the bladder tumor (TURBT), followed by concurrent (2) chemotherapy, and (3) radiation. Following induction therapy, histologic response is evaluated by cystoscopy and biopsy. Clinical complete responders continue with concurrent chemotherapy and irradiation. Those patients not achieving a clinical complete response are advised to undergo cystectomy. Individually the local monotherapies of radiation, TURBT, or systemic chemotherapy each achieve a local control rate of 20% to 40%. When they are combined, complete response rates of 70-80% are achieved and 85% of these will remain free of invasive recurrence in the bladder. Bladder preservation trials using combined modality treatment approaches with selection for organ conservation by response to initial treatment report an overall 5-year survival rate of approximately 50%, and they have achieved a 40% to 45% 5-year survival rate with the bladder intact. Modern multi-modality bladder preservation approaches offer survival rates similar to radical cystectomy, for patients of similar clinical stage and age, and an improved quality of life by allowing a majority of patients to retain their own fully functional bladder. Bladder conservation therapy may be offered to selected patients with bladder cancer as one alternative to radical cystectomy, and its use should be by experienced multi-modality teams of urologic oncologists.

Age Factors↗