Management of superficial bladder cancer in a community setting

Over the past four or five years, the urologist in private practice has gained experience using mitomycin in the treatment of superficial bladder cancers. Indications for use of mitomycin include carcinoma in situ (CIS), more than two or three recurrences on successive cytoscopic examinations of superficial transitional cell carcinomas, the presence of multiple transitional cell carcinomas at the time of initial examination when it was believed that all tumor could not be removed cystoscopically, and prophylaxis. The regimen for mitomycin has changed over time; currently the standard regimen is 40 mg mitomycin in 40 cc sterile water given intravesically once a week for eight weeks followed by routine cystoscopic examinations every three months and maintenance therapy, if indicated, of 40 mg mitomycin once a month. Results following use of this regimen in private practice have been most encouraging. Complications have been minimal. Only 1 patient had to discontinue therapy because of side effects, and 1 patient underwent radical cystectomy for recurrent disease after partial cystectomy and mitomycin therapy. Patients still receiving treatment include 1 patient who had not responded after initial treatment and who is being followed up for possible recurrence. Mitomycin therapy appears to be effective in controlling superficial bladder cancer and, possibly, carcinoma in situ, with minimal side effects and good patient compliance.