Benefits of Neoadjuvant Chemo

Dr. Stein never brought up pre-RC chemo to me as an option--instead he suggested that, in my situation, the sooner surgery was performed the greater the chance of success. He actually re-arranged his existing surgical schedule to accommodate me.

WEll T3 Grade 3 is definately an indication for chemo...no question there. What i'm questioning is the T2 Grade 2 which is now classified i guess to low grade since they've changed the system..and recommending chemo pre-cystectomy.
This has a lot of us wondering if we are getting the right advise. At the time and as i said 2003 Dr. Herr, Dr. Stein, Dr. Birhle, Dr. Schoenberg and Dr. Gill did not recommend pre-chemo with my T2 Grade 2 diagnosis. So are only MD Anderson and U of Penn recommending pre-chemo at the lower grade or have i misunderstood? Has everyone switched over since 2003?
Pat

Well I'm the current article then. I said I was allergic to the Gemzar and they switched me to the MVAC. My surgeon suggested the chemo before the surgery and after listening to him with my wife we both agreed with his decision. So by the grace of God and putting up a rough battle I am cancer free as of now (fingers crossed)
This was just a topic about the two chemos and I respect everyone on this board to make whatever decision they feel is right for them. And the article being 5 years old is really nothing this is a debate that has been going on for years. I just got over a left hip replacement and 3 days later I get hematuria (just friggin great b4 the holidays 12/06)and one month later I am getting a Turbt. I knew I had a 2 inch tumor before my Turbt but I didn't now the stage which turned out to be a T3 G3 so I had to make a decision quickly because like anyone I was nervous and scared. Other then that I really have nothing to say and hope all is well. Joe

Gee that was written in 2003 using the old MVAC......and i had my cystectomy in 2003 with T2 but only into the superficial muscle of the bladder with no indication of spread. Dr. Herr..no slouch in this department...never mentioned that i should be a candidate for chemo as all scans indicated that i was clean plus his second TURB cleaned out all the residual tumor and margins.......and i believe he said also that you only have one shot at that chemo. As it turned out after my cystectomy my bladder was completely disease free...a few radical dysplasic cells roaming around but that was it. So maybe i'm one of the lucky ones....but i'd like to see something more current that has been written. Pat

Pete I don't go by or rely on statistics because everyone is different. My surgeon explained his work in the past and he does like 150 RC's a year so I figured he must know what he talking about. To me the chemo is just that safety measure and I am glad I did it b4 then after the surgery because I could see where folks would not want to go through chemo if they didn't have to after that grueling surgery. I'm happy for what I did but in reality to each their own with their choice. Good Luck, Joe

I had my RC in 11/07, but no pre or post op chemo. Pathology report after surgery concluded a stage of pt2a, pNO, pMX. Since my pre-op tests indicated that the cancer was localized in the bladder, my surgeon felt chemo was not called for unless the surgery identified that the cancer had spread, which it didn't. I was surprised, but relieved, when the surgeon told me that I wasn't going to undergo pre-op chemo. Prior to my surgery, I had read some of the same trial results that indicated better survival rates with pre-op and post-op chemo, but to some extent they were inconclusive. In retrospect, I now wonder if I shouldn’t have insisted on pre-op chemo. Nevertheless, you can relate to what I was going through emotionally, at the time, and had heard such wicked things about the devastating effects of chemo that I relied on my urologist and surgeon. Oh well, thats water under the bridge. So far I'm cancer free, keeping my fingers crossed like you.

Regards,

Peter Konomos