Incidence and management of prostatic urethra recurrence in a cohort of 21 patients who received BCG induction for non-muscle invasive bladder cancer
•The Natural history of Prostatic Urethra recurrences after BCG Induction has not been well described in the literature.•Patients with Prostatic Urethra recurrences have a high-risk disease phenotype.•Radical Cystoprostatectomy is often first line treatment for these patients.•Conservative managemen...
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| Veröffentlicht in: | Urologic oncology 2024-09, Vol.42 (9), p.290.e11-290.e16 |
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| creator | Ingram, Justin W. Chung, Rainjade Laplaca, Caroline McKiernan, James M. Lenis, Andrew T. Anderson, Christopher B. |
| description | •The Natural history of Prostatic Urethra recurrences after BCG Induction has not been well described in the literature.•Patients with Prostatic Urethra recurrences have a high-risk disease phenotype.•Radical Cystoprostatectomy is often first line treatment for these patients.•Conservative management may be appropriate for well-selected patients who do not desire a cystoprostatectomy.
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).
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.
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.
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. |
| doi_str_mv | 10.1016/j.urolonc.2024.04.017 |
| format | Article |
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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).
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.
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.
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.</description><identifier>ISSN: 1078-1439</identifier><identifier>ISSN: 1873-2496</identifier><identifier>EISSN: 1873-2496</identifier><identifier>DOI: 10.1016/j.urolonc.2024.04.017</identifier><identifier>PMID: 38688797</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adjuvants, Immunologic - therapeutic use ; Aged ; Aged, 80 and over ; BCG Vaccine - administration & dosage ; BCG Vaccine - therapeutic use ; Carcinoma, Transitional Cell - pathology ; Carcinoma, Transitional Cell - therapy ; Cohort Studies ; Conservative treatment ; Cystectomy ; Humans ; Incidence ; Intravesical therapy ; Male ; Middle Aged ; Neoplasm Invasiveness ; Neoplasm recurrence ; Neoplasm Recurrence, Local ; Non-Muscle Invasive Bladder Neoplasms ; Prostatic Neoplasms - pathology ; Prostatic Neoplasms - therapy ; Retrospective Studies ; Transitional Cell carcinoma ; Urethral neoplasms ; Urethral Neoplasms - pathology ; Urethral Neoplasms - therapy ; Urinary bladder neoplasms ; Urinary Bladder Neoplasms - pathology ; Urinary Bladder Neoplasms - therapy</subject><ispartof>Urologic oncology, 2024-09, Vol.42 (9), p.290.e11-290.e16</ispartof><rights>2024 Elsevier Inc.</rights><rights>Copyright © 2024 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c313t-4bc541b6f67062b1b84ff1fb5271ebe58e162c2516a4f5443d3dd12615ed8a2f3</cites><orcidid>0009-0007-9674-3456 ; 0000-0002-7062-5001</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1078143924004368$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3536,27903,27904,65309</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38688797$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ingram, Justin W.</creatorcontrib><creatorcontrib>Chung, Rainjade</creatorcontrib><creatorcontrib>Laplaca, Caroline</creatorcontrib><creatorcontrib>McKiernan, James M.</creatorcontrib><creatorcontrib>Lenis, Andrew T.</creatorcontrib><creatorcontrib>Anderson, Christopher B.</creatorcontrib><title>Incidence and management of prostatic urethra recurrence in a cohort of 21 patients who received BCG induction for non-muscle invasive bladder cancer</title><title>Urologic oncology</title><addtitle>Urol Oncol</addtitle><description>•The Natural history of Prostatic Urethra recurrences after BCG Induction has not been well described in the literature.•Patients with Prostatic Urethra recurrences have a high-risk disease phenotype.•Radical Cystoprostatectomy is often first line treatment for these patients.•Conservative management may be appropriate for well-selected patients who do not desire a cystoprostatectomy.
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).
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.
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.
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.</description><subject>Adjuvants, Immunologic - therapeutic use</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>BCG Vaccine - administration & dosage</subject><subject>BCG Vaccine - therapeutic use</subject><subject>Carcinoma, Transitional Cell - pathology</subject><subject>Carcinoma, Transitional Cell - therapy</subject><subject>Cohort Studies</subject><subject>Conservative treatment</subject><subject>Cystectomy</subject><subject>Humans</subject><subject>Incidence</subject><subject>Intravesical therapy</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Neoplasm Invasiveness</subject><subject>Neoplasm recurrence</subject><subject>Neoplasm Recurrence, Local</subject><subject>Non-Muscle Invasive Bladder Neoplasms</subject><subject>Prostatic Neoplasms - pathology</subject><subject>Prostatic Neoplasms - therapy</subject><subject>Retrospective Studies</subject><subject>Transitional Cell carcinoma</subject><subject>Urethral neoplasms</subject><subject>Urethral Neoplasms - pathology</subject><subject>Urethral Neoplasms - therapy</subject><subject>Urinary bladder neoplasms</subject><subject>Urinary Bladder Neoplasms - pathology</subject><subject>Urinary Bladder Neoplasms - therapy</subject><issn>1078-1439</issn><issn>1873-2496</issn><issn>1873-2496</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkUGPFCEQhYnRuOvqT9Bw9NIjBTTdczI60XWTTbzomdBQOEy6YYTuMftD_L_SO6NXk0rg8L1XqfcIeQ1sAwzUu8NmyWlM0W4443LD6kD3hFxD34mGy616Wv-s6xuQYntFXpRyYAxkD_CcXIle9X237a7J77tog8NokZro6GSi-YETxpkmT485ldnMwdIl47zPhma0S86PeIjUUJv2KT-yHOixolVZ6K99WkkMJ3T04-62sm6xc0iR-pRpTLGZlmLH1eRkSsXoMBrnMFNrqnd-SZ55MxZ8dXlvyPfPn77tvjT3X2_vdh_uGytAzI0cbCthUF51TPEBhl56D35oeQc4YNsjKG55C8pI30opnHAOuIIWXW-4Fzfk7dm3XvpzwTLrKRSL42gipqVoweS2q_mKrqLtGbU1lJLR62MOk8kPGpheG9EHfWlEr41oVgdW3ZvLimWY0P1T_a2gAu_PANZDTwGzLjasCbtQM5y1S-E_K_4A04Sh6Q</recordid><startdate>20240901</startdate><enddate>20240901</enddate><creator>Ingram, Justin W.</creator><creator>Chung, Rainjade</creator><creator>Laplaca, Caroline</creator><creator>McKiernan, James M.</creator><creator>Lenis, Andrew T.</creator><creator>Anderson, Christopher B.</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0009-0007-9674-3456</orcidid><orcidid>https://orcid.org/0000-0002-7062-5001</orcidid></search><sort><creationdate>20240901</creationdate><title>Incidence and management of prostatic urethra recurrence in a cohort of 21 patients who received BCG induction for non-muscle invasive bladder cancer</title><author>Ingram, Justin W. ; Chung, Rainjade ; Laplaca, Caroline ; McKiernan, James M. ; Lenis, Andrew T. ; Anderson, Christopher B.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c313t-4bc541b6f67062b1b84ff1fb5271ebe58e162c2516a4f5443d3dd12615ed8a2f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Adjuvants, Immunologic - therapeutic use</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>BCG Vaccine - administration & dosage</topic><topic>BCG Vaccine - therapeutic use</topic><topic>Carcinoma, Transitional Cell - pathology</topic><topic>Carcinoma, Transitional Cell - therapy</topic><topic>Cohort Studies</topic><topic>Conservative treatment</topic><topic>Cystectomy</topic><topic>Humans</topic><topic>Incidence</topic><topic>Intravesical therapy</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Neoplasm Invasiveness</topic><topic>Neoplasm recurrence</topic><topic>Neoplasm Recurrence, Local</topic><topic>Non-Muscle Invasive Bladder Neoplasms</topic><topic>Prostatic Neoplasms - pathology</topic><topic>Prostatic Neoplasms - therapy</topic><topic>Retrospective Studies</topic><topic>Transitional Cell carcinoma</topic><topic>Urethral neoplasms</topic><topic>Urethral Neoplasms - pathology</topic><topic>Urethral Neoplasms - therapy</topic><topic>Urinary bladder neoplasms</topic><topic>Urinary Bladder Neoplasms - pathology</topic><topic>Urinary Bladder Neoplasms - therapy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ingram, Justin W.</creatorcontrib><creatorcontrib>Chung, Rainjade</creatorcontrib><creatorcontrib>Laplaca, Caroline</creatorcontrib><creatorcontrib>McKiernan, James M.</creatorcontrib><creatorcontrib>Lenis, Andrew T.</creatorcontrib><creatorcontrib>Anderson, Christopher B.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Urologic oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ingram, Justin W.</au><au>Chung, Rainjade</au><au>Laplaca, Caroline</au><au>McKiernan, James M.</au><au>Lenis, Andrew T.</au><au>Anderson, Christopher B.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Incidence and management of prostatic urethra recurrence in a cohort of 21 patients who received BCG induction for non-muscle invasive bladder cancer</atitle><jtitle>Urologic oncology</jtitle><addtitle>Urol Oncol</addtitle><date>2024-09-01</date><risdate>2024</risdate><volume>42</volume><issue>9</issue><spage>290.e11</spage><epage>290.e16</epage><pages>290.e11-290.e16</pages><issn>1078-1439</issn><issn>1873-2496</issn><eissn>1873-2496</eissn><abstract>•The Natural history of Prostatic Urethra recurrences after BCG Induction has not been well described in the literature.•Patients with Prostatic Urethra recurrences have a high-risk disease phenotype.•Radical Cystoprostatectomy is often first line treatment for these patients.•Conservative management may be appropriate for well-selected patients who do not desire a cystoprostatectomy.
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).
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.
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.
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.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>38688797</pmid><doi>10.1016/j.urolonc.2024.04.017</doi><orcidid>https://orcid.org/0009-0007-9674-3456</orcidid><orcidid>https://orcid.org/0000-0002-7062-5001</orcidid></addata></record> |
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| ispartof | Urologic oncology, 2024-09, Vol.42 (9), p.290.e11-290.e16 |
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| subjects | Adjuvants, Immunologic - therapeutic use Aged Aged, 80 and over BCG Vaccine - administration & dosage BCG Vaccine - therapeutic use Carcinoma, Transitional Cell - pathology Carcinoma, Transitional Cell - therapy Cohort Studies Conservative treatment Cystectomy Humans Incidence Intravesical therapy Male Middle Aged Neoplasm Invasiveness Neoplasm recurrence Neoplasm Recurrence, Local Non-Muscle Invasive Bladder Neoplasms Prostatic Neoplasms - pathology Prostatic Neoplasms - therapy Retrospective Studies Transitional Cell carcinoma Urethral neoplasms Urethral Neoplasms - pathology Urethral Neoplasms - therapy Urinary bladder neoplasms Urinary Bladder Neoplasms - pathology Urinary Bladder Neoplasms - therapy |
| title | Incidence and management of prostatic urethra recurrence in a cohort of 21 patients who received BCG induction for non-muscle invasive bladder cancer |
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