Tertiary experience of managing young bladder cancer patients

Abstract

Objective: Bladder cancer is rare in young patients and some authors have concluded that this group have a favourable outcome. We aimed to analyse our experience with such patients. Patients and Methods: Patients aged 50 years or younger were identified via a retrospective review of pathology samples between 2016 and 2020. Data regarding demographics, symptoms, stage, grade, size and multifocality at initial transurethral resection, recurrence rate and progression were analysed. Results: 60 patients with an average age of 42 were identified. The majority of patients presented with intermediate-risk non-muscle invasive bladder cancer (NMIBC). Four patients presented with muscle invasive and three with metastatic disease. There were seven deaths. Forty-nine patients with NMIBC were followed-up for an average of 5 years and 2 months. 41% of our cohort did not have a recurrence and only four moved up the risk stratification. No patients under 40 presented with muscle invasive disease and the majority had intermediate risk NMIBC. Conclusion: Young patients typically present with intermediate-risk NMIBC which rarely progresses. Very high-risk disease and aggressive variants do occur and may benefit from upfront cystectomy. The rate of muscle-invasive disease increases with age and rarely occurs under 40. Until more data is readily available, the management of this cohort of patients should follow the well-established guidelines. Level of evidence: 4 (case series)