Bladder Cancer Unexpectedly High in LUTS Minus Hematuria

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ATLANTA — Bladder cancer occurs more often than previously expected in patients presenting solely with lower urinary tract symptoms (LUTS) but without hematuria, according to a presentation at the 2013 meeting of the American Urological Association.1

Researchers from Emory University School of Medicine used a database from the Atlanta VAMC to study identify 331 male cancer patients. Of those patients, 14 (4.4%) presented solely with LUTS, a higher incidence than expected.

“Patients with bladder cancer usually present with either gross or microscopic hematuria,” according to the presentation abstract. “The incidence of lower urinary tract symptoms (LUTS) as the sole presenting symptom for bladder cancer has traditionally been reported to be low (1-2%). The objective of this study is to evaluate the prevalence, characteristics and outcomes of patients with bladder cancer who originally presented with LUTS in the absence of hematuria.”

At median follow-up of 52 months, recurrence after cystectomy in five patients and one patient experienced disease progression. As of the last follow-up, 11 patients were alive without recurrence, but three patients had died, one from bladder cancer.

“In contrast to prior reports, our database shows a greater percentage of patients with bladder cancer who present solely with LUTS. Furthermore, analysis of staging data at presentation demonstrates that a majority of patients with LUTS as their initial symptom did not have [carcinoma in situ] at the time of tumor resection,” concluded the authors, led by medical student Ryan Dobbs.

“Although this patient population is highly enriched with patients who are smokers and have a history of chemical exposure, this study suggests that urologists should have a low threshold for evaluating patients with irritative symptoms for underlying bladder cancer,” they added.

Dobbs, R, et al. (2013, May). Lower Urinary Tract Symptoms (LUTS) as a Presenting Symptom for Bladder Cancer in a Veteran Population. Presented at the American Urological Association 2013 meeting, San Diego, CA

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