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Conservative Approach to Bladder Cancer Debated

Some tumors have low risk of progression and can be managed expectantly

FRIDAY, Jan. 4 (HealthDay News) -- Conservative management of low-risk superficial bladder tumors may be an appropriate treatment strategy in some older individuals and those with co-morbid conditions who wish to avoid the risks of repeated transurethral tumor resections, provided that these patients undergo careful surveillance for tumor progression, according to an article published in the Journal of Urology in January.

Raj S. Pruthi, M.D., of the University of North Carolina at Chapel Hill, and colleagues report their clinical experience with 22 patients with superficial bladder cancer who were managed conservatively.

All 22 patients initially had low-grade tumors confined to the bladder lining (stage Ta). Over a mean follow-up of 25 months, eight patients experienced no tumor growth, nine had minimal growth and five had moderate growth. Three patients subsequently underwent office fulguration and four underwent repeat transurethral bladder tumor resection. Two patients had evidence of grade progression and one had a stage progression from Ta to T1. Smoking was associated with an increased rate of tumor recurrence.

The author of an associated editorial voices a word of caution regarding this conservative approach: "Until higher level evidentiary data are available on the safety and efficacy of expectant tumor management, and guidelines are established for appropriate patient selection and surveillance methods, expectant management should not be considered for standard practice."

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