Your opinion on this info!

Hi,

Yes, I know I normally do not chime in on these type of discussions, but I am compelled on this one.

It seems obvious to scrutinize this abstract as it is beyond vague. There is no mention of stage or grade stratifications which strikes me as rather important. I believe I have read numerous papers where it is clearly documented that high grade usually recurs as high grade and that similarly, low grade generally recurs low grade. Thus hanging onto a bladder with high grade bc is likely to be fatal. However if the bc is low grade and a RC is recommended, I would think it similar to amputating a finger to remove a wart for good.

I believe this paper has been recently on the ACOR list. It concerns me that a newbie with high grade and T2 invasion could be influenced to make a very poor decision. For that reason I have posted. Again, I have no experience with lowgrade or low stage bc, but I sure have my hands full coming to terms with T3b at age 44.

Holly

In regard to the study you presented, wouldn 't it appear that constant watch under any pre existing treatment is the KEY ? and yes, doesn't the status of the grading and typing make a big difference? Furthermore, is it a falacy that if one is proactive with surgery, you just push the cancer cell, faster throughout the system? or does that rogue cell have its own road map? I am trying to understand , that this BC attacks the linings of organs. How much can one stay ahead of its PATH?

Patricia wrote:
I believe the writter favors any treatment, over Rc. Seems he feels the long term outcome is about the same, with repeated TURBs, BCG, and close monitoring Vs the Rc. On the otherhand Stage 4, would likely rule differently!

Bill who wrote this? I would think a few omissions here specifically Stage and Grade? If its superficial T1 recurring then yes i probably agree...but there are plenty of papers out there that will tell you a Grade 111 recurrence is probably not a good thing.
I don't know....i've decided this cancer has a mind of its own and will make an appearance whenever it feels like it.
Pat

Well I had the last BCG (#6) treatment for round one, this Friday. I have a cysto scheduled for the second week of Aug. So, I have been doing a great deal of reading, to prepare myself, in case the cancer returns, and in case it's worse than last time.

So what is your opinion of the below data. It seems to favor, non-invasive treatment VS Rc?


Bladder Cancer Surgery

“Radical cystectomy has come to be the preferred method of treatment primarily because of the strong possibility of recurrence. While this is logical in theory, clinical experience
tells another story, and one which is considerably less clear-cut. It is true that radical cystectomy can reduce the local recurrence rate drastically, from around 70 percent down
to 10 percent, but, surprisingly, even though the recurrence rate can be cut so dramatically using radical cystectomy, radical cystectomy has not been shown to offer a clear survival advantage over less drastic methods of treatment.

In a classical study during the late 1980s, a group of patients who had had their bladder cancers excised using solely trans-urethral resection (TUR) were followed over a sevenyear period. During that time, 70 percent of the patients developed recurrences. Two thirds of the patients who suffered recurrences were operated on again with a repeat TUR, and continued to do well during the follow-up period. The other third of the
patients who suffered a recurrence underwent cystectomies. One third of these patients died during the follow-up period. The surprising finding was that the overall disease-free survival of the patients in this study was just over 80 percent.

The same researchers who conducted this study later went on to carry out another study in the mid-1990s, this time reviewing the experience of a number of urologists who were treating suitable bladder cancers with TUR only. The five-year survival rate for TUR treated patients with cancers that were deeply muscle-wall-invasive was 57 percent; for those with similar cancer who were treated by radical cystectomy it was 60 percent. The conclusion they drew from these figures was that TUR was as effective as radical cystectomy.

In another study, this time reviewing the long-term outcome of partial cystectomy, although 60 percent of the patients reviewed had subsequently developed a recurrence, all but 8 percent of these patients had their recurrences treated by local measures (TUR, fulguration). The remaining 8 percent required more invasive surgery (i.e., cystectomy)to control their recurrences.

The conclusion to be drawn fromthese various studies is that in many cases close and vigilant follow-up, rather than radical initial surgery, may offer the best possible chance of survival. Given that local recurrence is a strong possibility, early detection and prompt treatment of such recurrences provides the best chance for long-term health.

Of course, there is merit to the argument that initial radical cystectomy may obviate the need for repeat interventions. But if a patient is willing to accept the probability that repeat interventions will be necessary, bladder-sparing surgery is a good choice and one that will not compromise the prospects for survival.