UroToday - In a session moderated by Dr., Bernard Bochner, MSKCC a panel consisting of Drs. Harry Herr, Edward Messing, Dan Petrylak, and Seth Lerner had a lively discussion regarding management of high-risk bladder cancer patients.

In the first case, a 58-year old patient underwent TURBT and was found to have stage T1 micropapillary histology. Some members agreed to proceed with repeat TURBT, which is what Dr. Bochner did. The re-resection demonstrated persistent pT1b disease. Other panel members would have proceeded directly to cystectomy without re-resection. Dr. Petrylak advocated neo-adjuvant chemotherapy prior to cystectomy.

Responding to an audience question from Dr. Montie, University of Michigan, Dr. Reuter mentioned that substaging to T1a or T1b is not universally done since in 42% of specimens the histologic landmarks required to do this are not present in the specimen. He does do it at the individual request or discussion with the surgeon. In the actual case, pathology demonstrated pT2aN0 (0/48 nodes) TCC with micropapillary features.

Hypothetically, if the pathology also showed lymphovascular invasion Dr. Lerner then felt stronger that risk of metastatic was higher supporting a role for chemotherapy. Dr. Petrylak agreed with this. The panel was uncomfortable that the diagnosis of lymphovascular invasion on the TUR is convincing. This is because there is significant artifact on TUR that can impact the interpretation.

During the SUO meeting it was a repeated theme that pathologic interpretation of bladder cancer specimens has significant impact on treatment decisions such as T1 microstaging, presence of aberrant pathologic features, prostatic involvement and lymphovascular invasion. Working closely with one's pathologist will directly improve patient outcomes.

Report from The Society of Urologic Oncology Winter Meeting - National Institutes of Health - December 1-2, 2006 Reviewed by UroToday Contributing Editor Christopher P. Evans, M.D

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