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Can Stage 2 be diagnosed at first TURBT?

2 years 11 months ago #50282 by Alan
Sue,

To add what has been posted, my experience is almost exactly the same as youre. 1st TURB was inconclusive, some low grade and some grade 2 that might have even been grade 3. My URO is conservative and thankful that he is! I am around almost 8 years later. Sounds like you are in good hands.

DX 5/6/2008 TAG3 papillary tumor .5 CM in size. 2 TURBS followed by 6 instillations of BCG weekly with a second round of 6 after a 6 week wait.

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2 years 11 months ago #50279 by sara.anne
Sue, the answer is "it depends." IF muscle tissue was included in the first biopsy, it is certainly possible that a complete diagnosis could result the first time. Some urologists never do a second (I wouldn't want them to be my urologist!)
Sometimes there appears to be no need for a second. I suspect that in the case of a very small papillary tumor with no other areas "suspicious" it wouldn't be necessary.

Clear as mud!!!

Sara Anne

Diagnosis 2-08 Small papillary TCC; CIS
BCG; BCG maintenance
Vice-President, American Bladder Cancer Society
Forum Moderator

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2 years 11 months ago #50278 by Smayco
Thanks so much for your reply Sara Anne. So if I'm understanding you correctly, if there was muscle invasion, it would've most likely shown up the first time (but not definitely)?

My Uro is in his 50's, and he actually told me, "I have personally never found Stage 2 on any patient when I went back in a second time". Hopefully, he's just that good :-)


--Sue

Diagnosed 12/1/15
First TURBT 12/8/15
T1, "predominantly low grade, some high grade areas"
Second TURBT 12/29/15
BCG Jan-Mar 2016
4/25/16--All Clear!
Next cysto 7/25/16

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2 years 11 months ago #50277 by sara.anne
Your uro is "right on" as far as diagnostic tests are concerned. Studies have shown that too often the results of an initial TURB need to be refined by a second and this is not done often enough. The first time, the uro is sort of flying blind...he thinks he knows from what he has seen in cystoscopy where the problem areas are so that is where he takes samples. Sometimes he doesn't get enough tissue to include muscle. He is a bit cautious...doesn't want to perforate the bladder or do any damage. If he decides that a second TURB is necessary, he has a better idea of where to take samples and how deep to go. And yes, a first TURB can diagnose any stage....it just depends what the samples show.

The results from my first TURB showed papillary low grade, and "areas of undefined irritation." When my uro did a second, giving special attention to those areas, the results showed CIS which is high grade and requires immediate attention. So glad that my uro was enough on the ball to do the second.

Sounds as if you have a good urologist, and the BCG is indicated also.

Sara Anne

Diagnosis 2-08 Small papillary TCC; CIS
BCG; BCG maintenance
Vice-President, American Bladder Cancer Society
Forum Moderator

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2 years 11 months ago #50276 by Smayco
Hi all, I had my first TURBT on 12/8. The path report called it "Stage 1, predominantly low grade, with some high grade areas." My Uro said that, though my tumor was most likely going to behave like a low-grade, we needed to err on the side of caution and treat it as a high-grade. So I had my second TURBT yesterday and will start BCG in mid-January.

He had explained to me that I needed the second TURBT to make sure the tumor didn't invade the muscle. But yesterday he told me that he hadn't taken any muscle tissues during the first TURBT. So if this is standard procedure, how is it possible that anyone gets a diagnosis of Stage 2, or beyond, with their first TURBT? Should he have taken muscle tissue the first time, or is that only done if the surgeon suspects invasion? What would be the reason for him not to?

Thank you!

Diagnosed 12/1/15
First TURBT 12/8/15
T1, "predominantly low grade, some high grade areas"
Second TURBT 12/29/15
BCG Jan-Mar 2016
4/25/16--All Clear!
Next cysto 7/25/16

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