Paper Alert

Editor of Paper Alert
Edward M. Messing
University of Rochester Medical Center, Rochester, USA



Paper Alert 6

In 2014, I was on the Board of Directors of the Society of Urologic Oncology (SUO) when Merck announced having shortages of Tice strain Bacillus Calmette Guerin (BCG), a critical “drug” for treating intermediate and particularly high risk non-muscle invasive (NMI) urothelial cancer (UC) of the bladder, including carcinoma-in-situ (CIS) and high-grade (HG), stage Ta and T1 disease after transurethral resection.

Paper Alert 5

The standard initial treatment for urothelial cancer and other tumors of the bladder is a complete transurethral resection (TURBT). This is, of course, also a diagnostic and staging procedure and the information gained from both the endoscopic and histologic examinations have huge prognostic and management implications. But the hallmark of this procedure, particularly for non-muscle invading (NMI) urothelial cancers (UCs) is that all VISIBLE tumor is resected/ablated.

Paper Alert 4

Roughly 25% of patients at diagnosis of urothelial cancer (UC) have at least muscle invasive disease [1] and about half of these have extravesical extension or more advanced disease at that time. Additionally 10–15% of patients who initially have non-muscle invasive UC will subsequently develop muscle invasive or more advanced cancer. The outlook for patients with advanced or metastatic UC, particularly those who do not respond to Cisplatin-based combination chemotherapy regimens is very poor.

Paper Alert 3

Radical cystectomy is the gold standard treat-ment for muscle invasive (stage T2 – T4a) bladder cancer, but is associated with a high incidence of complications, readmissions, and mortality [1–3] partially because of the magnitude of surgery and partially because of the significant comorbidity bur-dens patients who develop this disease have [4, 5].

Paper Alert 2

Bladder cancer (BC) occurs roughly 3 times as often in men as women, not only in the United States, but worldwide [1]. This ratio has changed little over the past 30 years despite women entering the male workplace and increasing their relative exposure to bladder carcinogens such as those in cigarette smoke.

Paper Alert 1

This is the initial edition of Paper Alert in Bladder Cancer. Because of two recent shortages of BCG for treating non-muscle invasive (NMI) bladder cancer, (two to three years ago of the Connaught strain, and within the past year of the Tice strain), and with strains used in other countries not available in the United States, urologists have been faced with several problems in managing patients with NMI BC, particularly those with high grade disease.