Radical Cystectomy Suggested for T1G3 Bladder Cancer

The best treatment for patients with high-risk superficial stage T1, grade G3 (T1G3) bladder cancer is radical cystectomy, according to a new study.

Researchers of the University of Toronto (Canada) evaluated two treatment strategies for T1G3 bladder cancer using a decision-analytic Markov model. The researchers compared immediate cystectomy with neobladder creation to conservative management with intravesical bacillus Calmette-Guérin (BCG) and delayed cystectomy in individuals with resistant or progressive disease. Probabilities and utilities were derived from published literature where available, and otherwise from expert opinion.

The researchers found that the mean life expectancy (LE) of a 60-year-old male was 14.3 years for immediate cystectomy and 13.6 years with conservative management. With the addition of utilities, the immediate cystectomy strategy yielded a mean quality-adjusted life expectancy (QALE) of 12.32 years and remained preferred over conservative therapy by 0.35 years (about four months). Worsening patient co-morbidities diminished the benefit of early cystectomy but altered the LE-based preferred treatment only for patients over age 70 and the QALE-based preferred treatment for patients over 65. Sensitivity analyses revealed that patients over the age of 70, or those strongly averse to loss of sexual function, gastrointestinal dysfunction, or life without a bladder have a higher QALE with conservative therapy. The study was published in the September 25, 2007, issue of PloS Medicine.

"The decision to pursue immediate cystectomy versus conservative therapy should be based on discussions that consider patient age, comorbid status, and an individual's preference for particular post-cystectomy health states,” concluded lead author Girish Kulkarni, M.D., and colleagues of the department of Urology. "Patients over the age of 70 or those who place high value on sexual function, gastrointestinal function, or bladder preservation may benefit from a more conservative initial therapeutic approach.”

BCG is an inactivated form of the bacterium Mycobacterium tuberculosis. Although it is not yet totally understood why BCG and other immunotherapies work against cancer, they are thought to elicit an immune response. BCG has resulted in complete tumor regression in one half or more of treated patients with papillary tumors, and in more than 70% of those with carcinoma in situ (CIS).


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