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Radical cystectomy can improve outcomes among patients with muscle-invasive bladder cancer but appears to be underused in this patient population. These results were published in the Journal of the National Cancer Insitute.

The bladder is a hollow organ located in the pelvis. Its primary function is to store urine. The bladder has a muscular wall that allows it to get larger and smaller as urine is stored or emptied. Bladder cancer is diagnosed in roughly 50,000 men and 17,000 women annually in the United States.

Patients whose cancer has spread to deeper tissues in the bladder may be treated with a radical cystectomy, which is the surgical removal of the bladder and some nearby organs. Although guidelines commonly recommend cystectomy unless the patient is too ill to undergo the procedure, it appears that many patients with muscle-invasive bladder cancer do not undergo radical cystectomy.

Other treatments that may be used include chemotherapy and/or radiation therapy without radical cystectomy.

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To further understand why some individuals with muscle-invasive bladder cancer do not undergo radical cystectomy and to compare outcomes of different treatment approaches, researchers evaluated approximately 3,000 patients with Stage II bladder cancer. Participants were selected from Surveillance, Epidemiology, and End Results–Medicare data and were 66 years of age or older at the time of diagnosis; diagnosis occurred between 1992 and 2002.

  • Of the more than 3,000 study participants, 21% underwent radical cystectomy.
  • Patients undergoing radical cystectomy had better overall survival than those who received other treatments such as chemotherapy and/or radiation therapy.
  • Factors associated with not undergoing radical cystectomy included older age at diagnosis, health concerns in addition to bladder cancer, and long travel distance to their surgeon.

The researchers concluded that although radical cystectomy is recommended for many patients with Stage II bladder cancer, this treatment appears to be underused. Improved access to surgeons and more education about the risks and benefits of all treatment options may be warranted.

Reference: Gore JL, Litwin MS, Lai J, et al. Use of radical cystectomy for patients with invasive bladder cancer. Journal of the National Cancer Institute [early online publication]. April 16, 2010.