Muscle-invasive bladder cancer: does it arise de novo or from pre-existing superficial disease?

This study examines the clinical and pathologic features of 20 consecutive patients with muscle-invasive bladder cancer diagnosed between January 1, 1983, and December 31, 1984, at The Mount Sinai Hospital. On retrospective analysis, 18 patients (90%) had muscle-invasive bladder cancer at their initial presentation. The interval between onset of symptoms and histologic documentation of cancer was less than two months in 14 cases (78%), and in the remaining 22 per cent, the intervals of six, six, twelve, and twenty-four months were attributable to delay in seeking medical attention or delay in biopsy. In contrast, in the 2 patients who had presented with superficial tumors, the intervals were thirteen and one hundred eighty months. It therefore appeared that most patients with invasive bladder cancer had no therapeutically significant prior clinical or symptomatic history of superficial disease, and that invasion either was already present when symptoms had begun, or occurred rapidly after symptoms had initially appeared. These findings confirm the broad applicability of this pattern of bladder cancer in the general population, thereby complementing similar findings reported in recent years by secondary referral centers.