Symptoms and diagnostic delays in bladder cancer with high risk of recurrence: results from a prospective FinnBladder 9 trial.

To investigate the symptoms and delays in the clinical pathway of bladder cancer (BC).

This is a substudy of a prospective, randomized, multicenter phase III study (FinnBladder 9, NCT01675219) where the efficacy of photodynamic diagnosis and 6 weekly optimized mitomycin C instillations are studied in pTa bladder cancer with high risk for recurrence. The data of presenting symptoms and critical time points were prospectively collected, and the effect of factors on delays was analyzed.

At the time of analysis, 245 patients were randomized. Analysis included 131 patients with primary bladder cancer and their complete data. Sixty-nine percent had smoking history and 67% presented with macroscopic hematuria. Median patient delay (from symptoms to health-care contact) was 7 days. The median general practice delay (from health-care contact to urology referral) was 8 days. Median time from urology referral to cystoscopy was 23 days and from cystoscopy to TUR-BT 21 days. Total time used in the clinical pathway (from symptom to TUR-BT) was 78 days. Current and former smokers had non-significantly shorter patient-related and general practice delays compared to never smokers. TUR-BT delay was significantly shorter in patients with malignant cytology (16 days) compared to patients with benign cytology (21 days, p = 0.03).

Patient-derived delay was short and most of the delay occurred in the referral centers. The majority had macroscopic hematuria as the initial symptom. Surprisingly, current and past smokers were more prone to contact the health-care system compared to never smokers.

World journal of urology. 2019 Jun 08 [Epub ahead of print]

Ville Sell, Otto Ettala, Ileana Montoya Perez, Riikka Järvinen, Tarmo Pekkarinen, Markku Vaarala, Marjo Seppänen, Tapani Liukkonen, Timo Marttila, Sirpa Aaltomaa, Eero Kaasinen, Peter J Boström

Department of Urology, Turku University Hospital, Turku, Finland. ., Department of Urology, Turku University Hospital, Turku, Finland., Department of Future Technology, University of Turku, Turku, Finland., Department of Urology, Helsinki University Hospital, Helsinki, Finland., Department of Urology, Tampere University Hospital, Tampere, Finland., Department of Urology, Oulu University Hospital, Oulu, Finland., Department of Surgery, Satakunta Central Hospital, Pori, Finland., Department of Surgery, Mikkeli Central Hospital, Mikkeli, Finland., Department of Surgery, Seinäjoki Central Hospital, Seinäjoki, Finland., Department of Urology, Kuopio University Hospital, Kuopio, Finland., Department of Surgery, Hospital of Hyvinkää, Hyvinkää, Finland.

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