Staging should include chest imaging (CXR or CT) and CT urogram to assess the lungs and upper tracts/pelvic disease, respectively. Up to 42-73% patients will be upstaged at radical cystectomy highlighting limitations of current imaging modalities. Accuracy is mildly improved with MRI at 60% of patients upstaged at radical cystectomy. In a prospective trial at MD Anderson assessing utility of MRI, sensitivity and specificity is 100% and 78%, respectively. FDG PET may be limited due to urinary excretion and may be best suited to those with equivocal disease with 20% patients upstaged. Determining which treatment is best suited for a patient can be defined as ‘fitness’ for radical cystectomy. Mortality 90-d with surgery ranges between 0-11% with significant morbidity in >50% reported. Frailty measures include unintentional weight loss, exhaustion, weak grip strength, slow walking speed, low physical activity with the Frailty index being a standardized instrument to measure frailty. Frailty has been associated with complications in patients undergoing radical cystectomy and may be the appropriate measure determining which patients are best suited for a particular treatment.
Presenter: Eugene Lee, University of Kansas Medical Center
Contributed by Stephen B. Williams, MD, Assistant Professor, Division of Urology, The University of Texas Medical Branch at Galveston, Galveston, TX and Ashish M. Kamat, MD, Professor, Department of Urology, The University of Texas MD Anderson, Houston, TX
at the 2017 Genitourinary Cancers Symposium - February 16 - 18, 2017 – Orlando, Florida USA