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Open Access Research article

The natural history of secondary muscle-invasive bladder cancer

Guy Hidas1, Dov Pode1, Amos Shapiro1, Ran Katz1, Liat Appelbaum2, Galina Pizov3, Kevin C Zorn4, Ezekiel H Landau1, Mordechai Duvdevani1 and Ofer N Gofrit15*

Author Affiliations

1 Department of Urology, Hadassah University Medical Center, Jerusalem, Israel

2 Department of Radiology, Hadassah University Medical Center, Jerusalem, Israel

3 Department of Pathology, Hadassah University Medical Center, Jerusalem, Israel

4 Department of Surgery, Section of Urology, University of Montreal Hospital Center, Montreal, Canada

5 Department of Urology, Hadassah University Medical Center, PO Box 12000, Jerusalem, 91120, Israel

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BMC Urology 2013, 13:23  doi:10.1186/1471-2490-13-23

Published: 8 May 2013



The management of patients with high-grade non muscle invasive bladder cancer (NMIBC) brings diagnostic and therapeutic challenges. In the current study, we sought to study the natural history of progression to "secondary" muscle-invasive bladder cancer (MIBC)-cancer that developed during follow up of patients presenting with non-muscle invasive bladder cancer (NMIBC).


Between 1998 and 2008, 760 patients were treated for bladder cancer. Primary MIBC (>=T2) tumors (present upon presentation) were diagnosed in 114 patients. All patients with high-grade NMIBC were treated with intravesical BCG. Mean follow-up was 44 months.


Forty patients (6.1%) developed secondary MIBC after a mean period of 21 months from initial diagnosis of bladder cancer. The 2- and 5-year disease-specific survival rates were better for patients with secondary MIBC (90% and 56% compared to 69% and 42% for patients with primary disease, p=0.03). The Kaplan-Meier curves of the two groups were parallel but displaced by approximately 2 years.


In the current series, MIBC progression occurred among initially presenting patients with NMIBC in 6.1%. In most patients, the initial diagnosis of NMIBC is correct and muscle invasion occurs after a mean period of about 2 years. This supports a non-radical approach in patients with high-grade T1, Ta or Tis. Meticulous follow-up with liberal biopsy of any suspicious lesion may provide early diagnosis of invasive disease.

Bladder cancer; Muscle invasive; Progression; Survival; Outcomes; Accuracy; BCG; Intravesical therapy