Endoscopy may be effective in select TCC patients

Anaheim, CA-Patients with a relatively small volume of low-grade upper tract transitional cell carcinoma can be managed by purely endoscopic means over a long period of time, surgeons at the Jefferson Medical College, Thomas Jefferson University in Philadelphia reported at the 2007 AUA annual meeting here.

"Even patients with a low volume of higher-grade disease can be followed endoscopically, but it has to be done very diligently with very close surveillance, and that requires effort on the parts of the physician and the patients," Brent V. Yanke, MD, a fellow in endourology and laparoscopy working with Dr. Bagley, said.

"This can be done in most portions of the collecting system, and there are some patients who have a fair volume of tumor that we're able to resect completely using laser energy," Dr. Yanke told Urology Times.

Treatment pros and cons

"Whether it's in the bladder, urethra, or upper tract, TCC does tend to recur and to recur often," Dr. Yanke said. "When these tumors start out low-grade, they tend to stay low-grade. But, unfortunately, they do keep recurring. Some people will constantly be found to have tumor, but it will stay low-grade and noninvasive.

"So these patients have a lot of procedures and are coming in every 3 to 6 months, but the flip side is that they're keeping both kidneys and-particularly in people who are older and have renal insufficiency, or in those with just one kidney-you're giving them a way to avoid dialysis."

There were three deaths in the study, for an overall survival rate of 94.6%. One death was not connected with upper tract TCC, making disease-specific survival 96.4%. Two of the deaths occurred in patients with solitary kidneys.

Four patients were alive with metastatic disease, two of whom received chemotherapy and one who underwent radical cystoprostatectomy.

All but four patients in the study initially presented with upper tract TCC without bladder involvement. However, bladder TCC developed in 34 of these patients during follow-up (67%). In addition, bilateral disease developed in seven of the 44 patients with bilateral kidneys who initially presented with unilateral TCC. Ten of the 47 patients (21%) presenting with both of their kidneys eventually underwent nephroureterectomy.