Second Look, Second Chance? How a Repeat TURBT Can Change the Game for Bladder Cancer

TURBT, or transurethral resection, is a procedure used for the initial diagnosis and treatment of bladder cancer. It involves removing tumors from the bladder lining. However, it sometimes doesn't capture the full extent of the disease, leading to understaging. This is significant because inaccurate staging can result in inappropriate treatment strategies, especially for high-risk non-muscle-invasive bladder cancer (NMIBC). Understaging can lead to delays in administering the right treatment, potentially affecting patient outcomes. A more accurate assessment of the cancer's stage is critical for effective management.

Re-cTURBT, or repeat transurethral resection, is a second TURBT procedure performed after the initial one. It is important because it helps identify any remaining cancer cells or upstaging that the initial TURBT might have missed. This is especially crucial in high-risk NMIBC, where accurate staging is vital for effective treatment planning. Re-cTURBT helps in identifying persistent disease and ensures that the cancer is appropriately staged. In some instances, the upstaging rate can be significant, particularly when the initial TURBT sample did not include muscle tissue.

The study focused on patients diagnosed with pT1HG bladder cancer, which refers to high-grade T1 tumors. This is significant because high-grade T1 bladder cancer carries a higher risk of recurrence and progression compared to lower-grade tumors. These patients often require more aggressive management strategies. The study aimed to evaluate if a second TURBT (re-cTURBT) could improve the prediction of recurrence and progression in this specific group by identifying any residual tumors that were not detected during the initial TURBT.

The European Association of Urology (EAU) guidelines recommend a second TURBT (re-cTURBT) for patients with high-risk non-muscle-invasive bladder cancer (NMIBC), including those with pT1HG tumors. Following these guidelines ensures that patients receive the standard of care and that any residual tumors or upstaging are identified. Adhering to EAU guidelines is important as it helps standardize treatment approaches and improves patient outcomes by providing a framework for optimal management based on current evidence.

The study found that a persistent disease was present in 19.5% of patients after re-cTURBT. Additionally, 15.2% had high-grade NMIBC, and 4.3% were diagnosed with high-grade muscle-invasive bladder cancer (MIBC). These findings are significant because they demonstrate that re-cTURBT can reveal a considerable number of patients with residual disease or upstaging that was not detected in the initial TURBT. The study also revealed that patients with persistent disease after re-cTURBT had a higher recurrence rate compared to those with no residual tumor, emphasizing the value of re-cTURBT in predicting recurrence and progression.