Publications by authors named "Wei-Shen Tan"
Oncologic Outcomes of Sequential Intravesical Gemcitabine and Docetaxel Compared with Bacillus Calmette-Guérin in Patients with Bacillus Calmette-Guérin-Unresponsive Non-Muscle Invasive Bladder Cancer.
Eur Urol Oncol
December 2024
Background And Objective: Non-muscle-invasive bladder cancer (NMIBC) patients treated with additional bacillus Calmette-Guérin (BCG) may become unresponsive to BCG. Recently, sequential intravesical gemcitabine and docetaxel (gem/doce) are being used for NMIBC. This study aims to compare oncologic outcomes between sequential intravesical gem/doce versus additional BCG in patients with BCG-unresponsive NMIBC.
View Article and Find Full Text PDFArticle Synopsis
- - The study aimed to compare the cancer risks of bladder-sparing therapy (BST) versus radical cystectomy (RC) in patients with BCG-unresponsive non-muscle-invasive bladder cancer (NMIBC).
- - Data from 578 patients showed no significant differences in survival outcomes between the two treatment options, but the BST group had higher rates of high-grade recurrences and progressions to muscle-invasive bladder cancer (MIBC) over time.
- - The findings suggest that while BST and upfront RC provide similar survival rates in the intermediate term, patients receiving BST face increasing recurrence and progression risks, particularly with additional treatment attempts.
Article Synopsis
- There has been an increase in agents for treating bacillus Calmette-Guérin-unresponsive (BCG-U) non-muscle-invasive bladder cancer (NMIBC), and there is a pressing need for patient and therapy selection guidelines due to a lack of randomized trials.
- A global expert committee developed recommendations through literature reviews and a voting process, refining these guidelines during a live meeting in August 2023, achieving over 75% agreement on the final recommendations.
- No single optimal treatment exists for BCG-U patients; personalized treatment based on individual preferences, tumor characteristics, and available agent data is essential, with specific options recommended for carcinoma in situ and papillary-only tumors, and clinical trial participation encouraged.
Article Synopsis
- High-risk non-muscle invasive bladder cancer patients in Latin America have experienced BCG shortages, prompting studies on the effectiveness of reduced-dose (RD) versus full-dose (FD) BCG treatments.
- A retrospective study on 200 patients revealed that those receiving FD BCG had significantly lower recurrence rates and progression to muscle-invasive bladder cancer compared to those on RD BCG.
- Although RD treatment had fewer treatment discontinuations due to toxicity, it was linked to poorer oncological outcomes, suggesting that full-dose BCG is more effective for high-risk patients.
Background: Hematuria is a cardinal symptom of urinary tract cancer and would require further investigations.
Objective: To determine the ability of renal bladder ultrasound (RBUS) with the Hematuria Cancer Risk Score (HCRS) to inform cystoscopy use in patients with hematuria.
Design, Setting, And Participants: The development cohort comprised 1984 patients with hematuria from 40 UK hospitals (DETECT 1; ClinicalTrials.
Article Synopsis
- - The study aimed to assess how T1 substaging impacts the prognosis of non-muscle-invasive bladder cancer patients treated with either bacillus Calmette-Guérin (BCG) therapy or immediate radical cystectomy (iRC).
- - Out of 411 T1 high-grade patients analyzed, those demonstrating extensive/multifocal lamina propria invasion had worse outcomes, with a significantly higher likelihood of undergoing iRC and poorer survival rates when treated with BCG.
- - Despite these findings, T1 substaging did not significantly predict the likelihood of upstaging to more advanced disease during radical cystectomy.
Background: Age disparity in patients with non-muscle-invasive bladder cancer (NMIBC) exists. Whether this is due to differences in adequate cancer care or tumour biology is unclear.
Objective: To investigate age disparities in NMIBC using the Surveillance, Epidemiology, and End Results (SEER)-Medicare and UROMOL datasets.
Background: Testosterone replacement therapy is known to improve sexual function in men younger than 40 years with pathological hypogonadism. However, the extent to which testosterone alleviates sexual dysfunction in older men and men with obesity is unclear, despite the fact that testosterone is being increasingly prescribed to these patient populations. We aimed to evaluate whether subgroups of men with low testosterone derive any symptomatic benefit from testosterone treatment.
View Article and Find Full Text PDFBackground: European Urology Association (EAU) guidelines recommend immediate radical cystectomy (early RC) for patients with very high-risk (VHR) non-muscle invasive bladder cancer (NMIBC), with bacillus Calmette-Guérin (BCG) recommended only for those who refuse or are unfit for RC.
Objective: To describe oncological outcomes following BCG or early RC in a contemporary cohort of patients with VHR NMIBC (EAU criteria).
Design, Setting, And Participants: Patients diagnosed with VHR NMIBC between 2000 and 2020 were identified from our institutional NMIBC registry.
Purpose: We sought to determine if the International Bladder Cancer Group IR-NMIBC (Intermediate-risk Nonmuscle-invasive Bladder Cancer) scoring system can predict the requirement of delayed transurethral resection of bladder tumor in low-grade nonmuscle-invasive bladder cancer managed by active surveillance.
Materials And Methods: We prospectively studied recurrent low-grade Ta/T1 nonmuscle-invasive bladder cancer patients managed with active surveillance with the following characteristics: low-grade papillary nonmuscle-invasive bladder cancer, ≤5 apparent low-grade nonmuscle-invasive bladder tumors, tumor diameter ≤1 cm, absence of gross hematuria, and negative urinary cytology. Subsequent transurethral resection of bladder tumor was offered to patients who no longer met the inclusion criteria or patient choice.
Adjuvant treatment with either chemotherapy or bacillus Calmette-Guérin (BCG) is recommended for patients with intermediate-risk (IR) non-muscle-invasive bladder cancer (NMIBC). In this multi-institutional retrospective review, we evaluated oncological outcomes for 182 patients with IR-NMIBC treated with BCG (n = 100) or intravesical sequential gemcitabine and docetaxel (Gem/Doce; n = 82). Median follow-up was 48.
View Article and Find Full Text PDFObjective: To evaluate the impact of age on oncological outcomes in a large contemporary cohort of patients with non-muscle-invasive bladder cancer (NMIBC) treated with adequate Bacillus Calmette-Guérin (BCG).
Patients And Methods: We performed an Institutional Review Board-approved retrospective study analysing patients with NMIBC treated with adequate BCG at our institution from 2000 to 2020. Adequate BCG was defined as per United States Food and Drug Administration (FDA) guidelines as being receipt of at least five of six induction BCG instillations with a minimum of two additional doses (of planned maintenance or of re-induction) of BCG instillations within a span of 6 months.
Background: Data for bladder-sparing treatment (BST) in bacillus Calmette-Guerin (BCG)-unresponsive non-muscle-invasive bladder cancer (NMIBC) patients report short-term outcomes limited to 1-2 yr.
Objective: To assess long-term survival outcomes of BCG-unresponsive NMIBC patients treated with BST.
Design Setting And Participants: BCG-unresponsive NMIBC patients diagnosed between January 2000 and September 2021 from an institutional NMIBC registry were evaluated.
Article Synopsis
- The review compares recovery, oncological outcomes, and quality of life between open radical cystectomy (ORC) and robot-assisted radical cystectomy (RARC) for bladder cancer patients from randomized trials.
- RARC shows shorter hospital stays and similar complication rates compared to ORC, but ORC has shorter operative times and higher rates of blood loss and transfusions.
- RARC improves physical and role functioning but does not significantly enhance overall quality of life or survival rates, suggesting it may be preferable for patients wanting to minimize blood transfusions and hospital stays.
Purpose Of Review: Bladder cancer is the 12th most common cancer worldwide. Historically, the systemic management of urothelial carcinoma has been confined to platinum-based chemotherapy. In this review, we discuss the evolving landscape of systemic treatment for urothelial carcinoma.
View Article and Find Full Text PDFIntroduction: High grade, non-muscle invasive bladder cancer (NMIBC) is usually treated with intravesical Bacillus Calmette-Guérin. Chemohyperthermia therapy (CHT) may be a novel alternative therapy for the treatment of NMIBC.
Objective: To evaluate the recurrence-free survival (RFS) of patients treated with CHT using the Combat bladder recirculation system (BRS) for NMIBC.