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IVT Therapy & Decreasing Survival after RC

11 years 1 month ago #10392 by dmartin12358

so this is to imply that Columbia grossly understaged their patients?


No implication, it's a fact. Though I wouldn't use the word 'grossly' as that implies incompetence. But assuming Columbia has their diagnostic sh** together, understaging at their cancer center would be no different than that at MD Anderson or USC/Norris...

Understaging is the nature of the beast, so to speak. The most thorough way to stage bladder cancer is to remove the bladder (or lymph nodes...) for examination (and even this could miss microscopic traces of cancer).

All diagnostic techniques have limitations. Urine diagnostics may fail to detect high grade or low grade (depending on the test), or may fail to detect blc until it has advanced. Cystoscopy can only examine the interior surface of the bladder that is visible. Tumors can be on the interior/inside/outside of the bladder..., and can be blind to diagnostics.

That's one reason why bladder removal can be such a difficult decision for those of us with high grade cancer. Urologists/patients sometimes say 'all clear' when the more appropriate phrase is NED (no evidence of disease). 'Stealth' recurrence/progression occurs about 1/3 to 2/3 of the time for patients with high grade blc.






Dx 7/04, CIS + T1G3, Age 50
2 TURBTs
12 BCGs
Cystectomy 8/05 USC/Norris
So far, so good (kow)

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11 years 1 month ago #10391 by Patricia
so this is to imply that Columbia grossly understaged their patients?

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11 years 1 month ago #10380 by Rosemary
After mulling on this overnight, I've come to my best guess about this report, which is a conclusion like Warren's explanation....the possibility of UNDERSTAGING in initial dx.

This conclusion serves to support our advice to

ALWAYS OBTAIN A SECOND OPINION IN ANY BLADDER CANCER DIAGNOSIS.

See ya,
Rosemary

Rosemary
Age - 55
T1 G3 - Tumor free 2 yrs 3 months
Dx January 2006

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11 years 1 month ago #10378 by mznoregrets
Rosemary,

When I read stuff like that it makes me appreciate my neobladder even more. Those who are in the grey area - could try IVT but RC is an option too - have my prayers in making their choice. It just seems that there are many variables that make it a most difficult choice.
Bless you, Holly

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11 years 1 month ago #10376 by dmartin12358

I wonder what comparable studies are out there with places like Memorial Sloan, MD Anderson, Mayo, USC/Norris........???


Wsilberstein's explanation is likely correct. Here's what Dr. Stein from USC/Norris wrote in a 2003 paper about the incidence of clinical understaging in patients with superficial bladder cancer undergoing RC:

"Errors ranging from 34% to 62% have been reported in several large studies... Such inaccuracies lead to delays in definitive forms of therapy in time to achieve optiimal cure rates. Even if no errors in understaging occur, risks continue. Despite intravesical therapies, the potential for tumor progression, death, and treatment-related side effects remain."

There is much data showing that if high-grade cancer is contained in the bladder (hasn't yet progressed to the urethra or ureters or lymph nodes...), that definitive therapy has a high cure rate.

Dx 7/04, CIS + T1G3, Age 50
2 TURBTs
12 BCGs
Cystectomy 8/05 USC/Norris
So far, so good (kow)

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11 years 1 month ago #10371 by wsilberstein

The only interepretation that I can glean from this, is that IF your cancer progresses to the point of RC and you've had IVT (Intravesical Therapy) then the rate of survivorship goes down....

Any discussion on this?
Rosemary

"BJU Int. 2007 Jul;100(1):33-6.
The increasing use of intravesical therapies for stage T1 bladder cancer coincides with decreasing survival after cystectomy.

A relationship may not imply cause and effect. One possible explanation is that IVT decreases the rate of early RC so that some patients who would have done better with RC delay RC until after their disease has spread. This may relate to understaging since IVT is intended for superficial disease and understaged patients won't find out they've been understaged initially until a recurrence shows invasion, a node or metastasis shows up, or the staging is changed at RC.
If this is the explanation, it isn't the IVT which decreases survival, but rather the delay in RC which treatment with IVT makes possible.

-Warren
TaG3 + CIS 12/2000. TURB + Mitomycin C (No BCG)
Urethral stricture, urethroplasty 10/2009
CIS 11/2010 treated with BCG. CIS 5/2012 treated with BCG/interferon
T1G3 1/2013. Radical Cystectomy 3/5/2013, No invasive cancer. CIS in right ureter.
Incontinent. AUS implant 2/2014. AUS explant...

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