First, Dr. Badrinath discussed some papers on bladder cancer. The first mentioned paper was on trimodal therapy in advanced bladder cancer and recurrence in the form of non-muscle invasive bladder cancer (NMIBC), by Sanchez A. et al.1. In this paper, the authors showed that 25% of bladder cancer patients treated with trimodal therapy, instead of radical cystectomy, have a recurrence manifesting as NMIBC disease. Carcinoma in situ (CIS) was the most common finding in these patients. The median time to recurrence was 1.8 years with 36% and 46% of the patients treated with BCG having recurrence and progression, respectively. Importantly, 49% of the patients experienced some form of toxicity from trimodal therapy, and 21% died from the disease. The authors concluded the finding of CIS after trimodal therapy is a bad prognostic sign.
The next bladder cancer paper discussed assessed the impact of 5-Alpha-reductase inhibitors (5ARI) on bladder cancer, by Makela V. et al.2. A total of 10,720 men were analyzed. The mean follow-up was 4.1 years. Interestingly, the results showed that 5ARI might be associated with a lower risk of bladder cancer death.
Dr. Barinath then discussed a paper comparing CT urography (CTU) vs. ultrasound for the evaluation of microhematuria and macrohematuria, by Tan WS. et al.3. Out of a total of 3,556 patients, 60% of the patients were assessed with ultrasound and 40% with CTU. Out of all the patients with macrohematuria, 2.2% had a risk of malignancy, while 0.4% of the patients with microhematuria had a risk of malignancy. The ultrasound was demonstrated to have a negative predictive value of 99.9% for renal cell carcinoma (RCC) and 99.7% for upper tract urothelial carcinoma (UTUC). The ultrasound had a sensitivity of 77% for UTUC and 82% for RCC.
The next bladder cancer paper discussed was a study assessing nutritional supplementation in patients undergoing radical cystectomy, by Ritch et al.4. This was a randomized trial (n=61) randomizing patients to receive either Ensure 2/d or multivitamin infusion 2/d for a duration of 8 weeks. The authors demonstrated that the Ensure group had no change in skeletal muscle mass postoperatively, and the multivitamin group had a higher rate of complications.
Dr. Badrinath then moved on to discuss a paper on testicular cancer treatment and its association to erectile dysfunction, by Bandak M et al.5. A total of 2,260 patients were asked to fill the International index of erectile function (IIEF) questionnaire with 60% of the patients responding. The median follow-up time was 17 years after diagnosis. A total of 83%, 79%, 76%, and 70% of patients who were on surveillance, chemotherapy, radiotherapy and more than one line of treatment, respectively, had good IIEF scores. All therapies had lower good IIEF scores than surveillance.
Lastly, Dr. Badrinath moved on to discuss a penile cancer paper. This was a study assessing penile sparing surgery in patients with T2 penile cancer, by Baumgartner A et al.6 This was a multicenter study with 1,351 patients analyzed, and all had a positive margin, with 33% of them having T2 disease, and 20% were with a local recurrence. The authors demonstrated that penile sparing surgery is possible even for T2 disease.
Presented by: Badrinath Konety, MD, MBA, CEO, University of Minnesota Physicians, Vice Dean for Clinical Affairs, University of Minnesota Medical School, Associate Director, Clinical Affairs & Clinical Research, Masonic Cancer Center
Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre, Twitter: @GoldbergHanan at the American Urological Association's 2019 Annual Meeting (AUA 2019), May 3 – 6, 2019 in Chicago, Illinois
1. Sanchez A. et al. J UROL 2018
2. Makela V. et al. J UROL 2018
3. Tan WS et al. J UROL 2018
4. Ritch et al. J UROL 2018
5. Bandak M. et al. J UROL 2018
6. Baumgartner A. et al. J UROL 2018