BERKELEY, CA (UroToday.com) - The literature suggests that patients with high grade T1 bladder cancer may be upstaged 40 - 70% of the time after repeat resection, especially if detrusor was not present in the initial specimen. While most urologists will re-resect patients without muscle in the specimen, re-resection of all high risk superficial bladder tumors is not routine. Some urologists feel that if "I did the resection" and muscle was present, the patient may proceed directly to intravesical BCG and undergo a second resection after intravesical therapy.

In the December issue of the Journal of Urology, Herr from Memorial Sloan-Kettering Cancer Center reported on a retrospective series of 347 patients with high risk superficial bladder cancer defined as Ta, T1 high grade tumors with carcinoma in situ. Patients underwent a restaging TUR (215 pts.) or proceeded directly to intravesical BCG therapy followed by repeat resection (132 pts.). Patients did not undergo maintenance BCG therapy. Response was assessed at 6 and 12 months post BCG.

Patients who underwent a single TURBT were more likely to have residual tumor (57%) at the first cystoscopy compared with patients who underwent a second staging TURBT (29%). Similarly, the rate of progression was higher in patients with a single TUR (34%) compared with patients who had been re-resected (7%) (p = 0.0001)

In summary, this study suggests those patients with high risk superficial bladder cancer who undergo a second staging TUR benefit from an improved response to intravesical BCG and a lower rate of progression. Although maintenance BCG was not used, the differences seen between groups at the first cystoscopy were dramatic.

J Urol. 2005 Dec; 174(6):2134-7