When bladder cancer invades the muscles, reaching stage T2, removing the bladder is an established treatment protocol. However, in 50% of patients at stage T2, there is metastasis outside the organ. Therefore, performing bladder removal surgery at stage T1 for high-risk bladder tumors is becoming a new treatment protocol worldwide. Even at stage T1, the rate of metastasis outside the organ is 15%.

What constitutes high-risk bladder cancer: Who are these patients?

– Those with a high tumor burden in the bladder despite being at stage T1, or those with very large tumors.

– Those with numerous or large high-grade Ta tumors in the bladder.

– Those diagnosed with stage T1:

  – Micropapillary variant

  – Sarcomatoid variant

  – Sarcoma

  – Small cell carcinoma

  – Plasmacytoid variant

In which cases should a bladder removal surgery be performed instead of bladder-sparing treatment in patients with T1 stage tumors, i.e., tumors that have not invaded the muscle?

– T1 tumors larger than 3 cm or more than 3 T1 tumors

– Presence of T1 tumor in the bladder after re-TUR

– Patients who do not respond to BCG therapy

– T1 tumor with lymphovascular invasion

– T1 tumors with Micro-papillary Variant; Sarcomatoid Variant; Small cell tumor; Bladder sarcoma; Plasmacytoid Variant in pathology report

– Dilation in one or both kidneys with T1 tumors

– Patients who cannot receive BCG due to side effects

– Presence of a tumor in the prostate in addition to T1 bladder cancer

What is Re TUR and which patients should undergo it?

Re TUR is a procedure performed 2-6 weeks after the initial TUR Tm surgery in cases of bladder cancer, especilly to establish genuine stage (T1-T2)

– Patients whose pathological examination after the initial TUR Tm surgery reveals T1 stage.

– Patients whose pathological examination after the initial TUR Tm surgery reveals T1 stage but does not include muscle tissue in the sample.

– Patients whose pathological examination after the initial TUR Tm surgery reveals high-grade Ta stage tumors.

During a 10-year follow-up of bladder cancer cases genuinely at stage T1:

1) In one-third of these patients, the disease progresses, necessitating the removal of the bladder.

2) One-third of these patients fully recover with TUR Tm surgery and BCG therapy.

3) One-third of these patients experience indecision about treatment, delay it, and die.