Gender-Related Differences in Clinical and Pathological Characteristics and Therapy of Bladder Cancer

Objective: To confirm the very high male:female ratios previously observed among Spanish bladder cancer patients and to assess gender differences in tumoral characteristics, diagnostic procedures, and treatment in a large series of consecutive bladder cancer patients. Patients and Methods: All newly diagnosed bladder cancer patients ( n=615) in 17 Spanish hospitals, between 1997–2000, were included. Information was collected both through personal interviews to patients and from medical records using a structured form. Results: Seventy-six percent of tumours were superficial. The male:female ratio was 6.7 and it was similar for superficial and infiltrating tumours. Women were older than men at the diagnosis of bladder cancer (68.2±9.4 years versus 65.7±9.7 years, p=0.01). Ten percent of superficial tumours in women, versus 3% in men, were classified as “other histological types” ( p=0.008). T1GIII tumours were more frequent among men (17% versus 7%, p=0.047). On the other hand, women were more likely to present with 0a-stage tumours (48.6% versus 35.5%, p=0.04), multiple tumours (50% versus 29%, trend test: 0.005), multi-centric tumours (54% versus 38%, p=0.019), and larger infiltrating masses (5.2 cm versus 3.8 cm, p=0.03) than men. Among 0a-stage tumours, only 23% of women compared to 54% of men received transurethral resection (TUR) alone ( p=0.002). Women were almost five-fold more likely to receive additional therapies to TUR ( p=0.004) after adjusting for age, geographical area, stage, tumoral size, nuclear grade, and multiplicity. Conclusion: The study confirms the very high male:female ratio of bladder cancer in Spain. We found substantial differences in the pathological characteristics of tumours from men and women. There was a tendency for women to receive more frequently non-standard, more aggressive, therapy than men.