Staging and prognosis of T3b bladder cancer

Individuals with extravesical extension of bladder cancer (stage T3b) have a worse prognosis than those with muscle-invasive disease confined to the bladder. Accurate staging of T3b bladder cancer becomes increasingly important as more effective methods of treating high-stage bladder cancer are developed. Despite aggressive attempts over the last three decades to stage muscle invasive disease more accurately, bladder cancer is still staged incorrectly in 30% to 50% of patients. The basis for accurate clinical staging resides in a thorough endoscopic resection and a careful bimanual examination. Imaging studies (transurethral ultrasonography, computed tomography [CT], and magnetic resonance imaging [MRI] can increase the accuracy of staging but are most reliable when performed before transurethral resection.