Bladder tumours detected on screening: results at 7 years

To report the outcome at a minimum follow-up of 7 years of a cohort of tumours that were asymptomatic at presentation and detected in a previous community-based screening programme (with reduced mortality and progression at 3 years of follow-up).

In the original screening, 2356 men aged > or = 60 years had a dipstick test for microscopic haematuria; 474 (20%) had positive results and of these, 317 agreed to further investigation. Twenty-one were found to have bladder tumours; this was reduced to 17 after pathological review. No tumours were muscle-invasive at diagnosis. The outcome of this cohort was evaluated at 7 years of follow-up.

The patients were grouped on the basis of their original histology. In group A, four patients had no tumour on histological review and none progressed in grade or stage. In group B, eight patients reported to have well differentiated superficial tumours (i.e. G1pTa) had no recorded deaths from cancer or progression to muscle-invasive disease. In group C, of nine patients with tumours having a potentially worse prognosis (G1-2, > or = pT1, or carcinoma in situ, three died from bladder cancer, two progressed to muscle-invasive disease (one of whom died from unrelated causes) and two further patients died from unrelated causes.

This cohort of patients represents a unique group, in that all had superficial disease at the time of diagnosis. The outcome at 3 years was excellent, but in the subsequent 4 years many patients had progression of their cancer. All patients who developed invasive disease were in group C; as their disease was identified at a superficial stage it may have been amenable to aggressive early management not usually associated with such grade and stage.