Instillation therapy in superficial urinary bladder cancer. Finnbladder Group.

Carcinoma in situ (TIS) is a special dilemma. Controversial diagnostic and therapeutic attitudes prevail in the literature. Mild dysplasia grade 1 seems to be a condition where 'wait-and-see policy' might be justified according to our series of 60 patients with a TIS whereas, both the TISG2 and TISG3 are real malignancies which need a more aggressive treatment than a transurethral resection (TUR) alone. Under a close control, intravesical chemo- and immunotherapy offer an alternative to cystectomy. On the other hand, for a visible superficial (Ta-T1) cancer TUR is the principal treatment, which can easily be repeated. Anyhow, the high frequency of recurring tumours and the tendency to simultaneous progression in a specific category of patients have led to adJuvant prophylactic treatments. Currently, both intravesical cytostatics and intravesical bacillus Calmette-Guérin have been proven safe with much the same effect. Adjuvant prophylaxis of a primary, single superficial tumour is not indicated, even though the treatment of T1G3 cancer is under discussion.

Immunoreactivity of bcl-2, p53 and EGFr is associated with tumor stage, grade and cell proliferation in superficial bladder cancer. Finnbladder III Group.

Immunoreactivity of bcl-2, p53, the epidermal growth factor (EGFr) and Ki-67 (MIB-1) proteins was assessed by immunohistochemistry in 185 patients with superficial bladder cancer (SBC) in order to evaluate their usefulness as indicators of tumor progression. Forty-one percent of the tumors were bcl-2 positive, 36% of them were positive for p53 (over 20% of nuclei), while 41% were positive for EGFr, and 30% of the tumors were MIB-1 positive (proliferation index > 15%). Immunoreactivity of all analyzed proteins was highly significantly related to tumor grade and stage. Tumors which were bcl-2, p53 or EGFr positive were also rapidly proliferative (MIB-1 score >15%). The obtained results suggest that all analyzed proteins may have prognostic significance in SBC. The prognostic value of the abnormal immunolabeling of the analyzed proteins will be established after an adequate follow-up period of this same cohort of patients.