Management of T1G3 Bladder Cancer

, Youn Soo Jeon

Review Article

The Korean Journal of Urological Oncology 2007;5(2):74-79.
Published online August 1, 2007.

Management of T1G3 Bladder Cancer

Youn Soo Jeon

Department of Urology, Soonchunhyang University College of Medicine, Cheonan, Korea

Abstract

Approximately 70-80% of patients with bladder cancer are found to have non-invasive diseases (Ta or T1). Ta or T1 bladder tumors are not promptly fatal disease but about 70% of them may recur and subsequently 15-20% will progress to a higher stage. High grade bladder tumors invading the lamina propria (T1G3 bladder cancer) have more aggressive biologic behaviors than other non-invasive bladder tumors. T1G3 bladder tumors have a high propensity for recurrence and progression. Over 70% of these tumors may recur and as many as 50% of them will progress. The optimal treatment of T1G3 bladder tumor depends on an accurate diagnosis and staging, and careful assessment of prognostic factors. In most patients with T1G3 bladder tumors, the initial step of management is to establish an accurate diagnosis including the stage and grade, followed by perioperative intravesical chemotherapy, or postoperative intravesical BCG. And then closed surveillance with long-term follow-up is imperative for managing these tumors. Many authors have reported a high risk of residual tumors and understaging after initial TUR-BT of the patients with T1G3 bladder tumors. Restaging TUR is recommended in most patients with these tumors to remove residual tumors and for reducing staging errors. Clinical and pathological prognostic factors should be assessed to select proper treatment options. Important prognostic markers for T1G3 tumors are early recurrence after TUR and BCG therapy, concomitant carcinoma in situ, involvement of prostatic urethra and depth of lamina propria invasion, as well as tumor size and multiplicity. In selected patients with poor prognostic factors, immediate radical cystectomy should be considered. Radical cystectomy in T1G3 bladder tumors offers best results in regard to recurrence and progression free survival rate, whereas inappropriate treatment adversely impact on survival of the patient. However, overtreatment affects the quality of life and can result in unnecessary morbidity. Despite advances in the understanding of the biologic behavior of these tumors, both the choice and timing of treatment remain controversial. (Korean J Urol Oncol 2007;5:74-79)

Key Words: Bladder cancer, Stage T1, High grade, Treatment