The correlation of T1 bladder tumour history with prognosis and follow-up requirements.

The histories of 332 T1 bladder cancer patients were studied to determine the natural history in this tumour population. Each was followed for at least 5 years or to earlier tumour death and the approach to treatment was conservative. Patients were potentially at serious risk of disease progression and death if they presented with tumours of G2 or G3 grade and grew new ones again after treatment or if they exhibited a continuous high level of tumor neogenesis. Fourteen developed urothelial tumours beyond the bladder, evidence of widespread urothelial instability. Tumour deaths accounted for only 12% of the series, justifying a conservative approach to treatment, and a further 25% died from unrelated causes. Those remaining tumour-free at 5 years had a low malignant potential and their natural history supported discontinuing routine cystoscopy after that time.