Abstract
Approximately 20-30% of non-muscle invasive bladder urothelial carcinomas invade the lamina propria and are staged as T1. They represent a therapeutic challenge because of their highly malignant potential.
Their individual clinical behavior is difficult to predict, and despite recent developments, their molecular profile and position in pathogenic pathways remain enigmatic. Patients with T1 urothelial carcinoma are at risk of tumor recurrence and, more important, at risk of disease progression.
Without bacillus Calmette-Guérin (BCG) treatment, the progression into muscle-invasive disease threatens 18-40% of patients with T1 urothelial carcinoma. In 848 BCG-treated patients from Club Urológico Español De Tratamiento Oncológico (CUETO) trials, the progression to muscle invasion appeared in 15% of T1 cases (Luis Martinez-Piñeiro, personal communication, September 2009).
Despite this unfavorable prognosis, I believe that outcomes can be improved by utilization of current clinical experience and technical progress. The data from the prospective randomized trial managed by the Urothelial Cancer Group of the Nordic Association of Urology (NAU) and published in this issue offer the perfect opportunity to consider and discuss some options and critical points [2].
The management of T1 bladder urothelial tumors is based on three milestones: complete transurethral resection (TUR), effective intravesical treatment, and early detection of treatment failure and timely indication of radical cystectomy.