Positive urinary cytology following a complete response to intravesical bacillus Calmette-Guerin therapy: Pattern of recurrence Journal Article
| Authors: | Schwalb, M. D.; Herr, H. W.; Sogani, P. C.; Russo, P.; Sheinfeld, J.; Fair, W. R. |
| Article Title: | Positive urinary cytology following a complete response to intravesical bacillus Calmette-Guerin therapy: Pattern of recurrence |
| Abstract: | The pattern of disease recurrence was examined in 75 patients with clinically undetectable positive urinary cytology results following a complete response to intravesical bacillus Calmette-Guerin (BCG) therapy for superficial bladder cancer. A complete response was defined as negative cystoscopy and biopsy findings, urine cytology and flow cytometry (when available) for at least 1 year following therapy. Urinary cytology was positive in the absence of clinical disease at a median of 25 months (range 12 to 96) after BCG administration. Clinically recognizable disease (defined by a positive biopsy or visible papillary tumor) developed at a median of 6 months (range 2 to 60) after positive cytology was detected in 62 patients (83%), while 13 (17%) had persistently positive cytology results without an obvious source at a median of 6 months (range 2 to 29). The bladder was the single most common site of recurrence, with 39 recurrences developing in 36 patients (58%, 3 of whom had recurrent cancer after a complete response to each of 2 separate courses of BCG): 30 (77%) were superficial (stages Ta in 2, Tis in 25, Tis/T1 in 2 and T1 in 1) and 9 (23%) were invasive (stage T2+). Median interval to the detection of bladder recurrence following a positive cytology result was 6 months (range 2 to 50). Upper urinary tract disease developed at a median of 7 months (range 2 to 41) in 11 patients (18%), while 7 (11%) had a prostatic recurrence at a median of 5 months (range 2 to 60). There were 9 synchronous bladder and prostate (5) or upper tract (4) recurrences in 8 patients (13%) at a median of 22 months (range 2 to 40) in the former group and 15.5 months (range 3 to 20) in the latter group. Overall, of 75 sites of recurrence in 62 patients 48 (64%) were in the bladder, 15 (20%) in the upper urinary tract and 12 (16%) in the prostate. High risk patients with superficial bladder cancer who have clinically unconfirmed positive urinary cytology results following a complete response to intravesical BCG therapy require aggressive evaluation of intravesical and extravesical sites to detect the presence of persistent or progressive in situ or invasive disease. |
| Keywords: | adult; major clinical study; cancer localization; cancer recurrence; cisplatin; doxorubicin; methotrexate; cancer staging; flow cytometry; cancer grading; bcg vaccine; metastasis; recurrence; bladder cancer; thiotepa; vinblastine; high risk patient; prostate cancer; injection; cystectomy; urine; bladder neoplasms; cystoscopy; mitomycin; intravesical drug administration; urine cytology; bladder biopsy; intravenous urography; retrograde pyelography; human; male; female; priority journal; article |
| Journal Title: | Journal of Urology |
| Volume: | 152 |
| Issue: | 2 Pt. 1 |
| ISSN: | 0022-5347 |
| Publisher: | Elsevier Science, Inc. |
| Date Published: | 1994-08-01 |
| Start Page: | 382 |
| End Page: | 387 |
| Language: | English |
| DOI: | 10.1016/s0022-5347(17)32744-1 |
| PROVIDER: | scopus |
| PUBMED: | 8015076 |
| DOI/URL: | |
| Notes: | David M. Schwalb is listed as M. David Schwalb on the original publication -- Export Date: 14 January 2019 -- Article -- CODEN: JOURA C2 -- Source: Scopus |
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