Extravesical tumor relapse in patients with superficial bladder tumors

To define the incidence of extravesical urothelial tumors among patients with high-risk superficial bladder tumors. Three hundred seven patients with multiple recurrent papillary and in situ carcinomas of the bladder were treated with transurethral resection and intravesical bacillus Calmette Guérin (BCG) therapy and monitored for a median of 12 years (range, 10 to 18). Extravesical tumors were detected during investigation of a positive urine cytology after no tumor was found in the bladder. Among 307 patients, 78 (25%) developed tumors in the upper urinary tract (UTT). Of 251 men, 61 (24%) had tumors detected in the prostatic urethra or ducts (T4p). The median times to detection of an UTT or prostatic epithelial tumor were 56 months and 11 months, respectively, and 32% of the UTT and 44% of the T4p relapses were lethal. Patients with high-risk superficial bladder tumors who are treated successfully by a bladder-sparing strategy are at increased risk for tumor relapse that involves extravesical mucosa.