High-grade non-muscle-invasive bladder cancer: is re-resection necessary in all patients before intravesical bacillus Calmette-Guérin treatment?

Abstract

Objective: According to current European Association of Urology (EAU) guidelines, a routine second transurethral resection (TUR) is mandatory in TaG3 and T1 tumours, but the scientific evidence is weak. The aim of this study was to report outcome data for patients not subjected or subjected to a routine second resection.

Material and methods: This retrospective study included 221 patients with a newly diagnosed TaG3 or T1 bladder cancer treated with intravesical bacillus Calmette-Guérin (BCG).

Results: A routine second resection or a repeat resection was done in 57 out of 221 patients (25.8%). During the first year, progression was diagnosed in 0/10 patients with TaG3, 2/12 with T1G2 and 5/35 with T1G3. Among 164 not subjected to a second resection, the progression rate during the first year was 0/56 for patients with TaG3, 1/30 for T1G2 and 8/78 for T1G3. The median age among all 16 patients with T1 tumours who progressed during the first year was 77.5 years (27-94 years). Twenty-five TURs (25/164, 15.2%) were performed among the 164 patients because of a tumour at the first cystoscopy. The majority (84/164, 51.2%) had no recurrences during a median follow-up of 45 months.

Conclusions: The initial outcome was very good for TaG3 patients, so a routine re-resection may be unnecessary. However, progression among T1 patients was common, and therefore a re-resection should be strongly considered. The potential benefit of a second TUR should be weighed against costs and morbidity in a predominantly elderly population. The absence of prospective randomized studies is problematic.