title: Diagnostic random bladder biopsies: reflections from a population-based cohort of 538 patients.
abstract: OBJECTIVE
  To assess whether diagnostic random bladder biopsies and the detection of concomitant carcinoma in situ (CIS) have an impact on the frequency of intravesical bacille Calmette-Guérin (BCG) instillations or radical cystectomy; and whether this affects the cancer-specific survival in patients with pTaG3 or pT1G1-G3 transitional cell carcinoma of the urinary bladder.
  
  
  METHODS
  A population-based cohort of 538 patients with newly diagnosed bladder cancer was prospectively registered in the Stockholm County during 1995 and 1996 and followed for more than 5 years.
  
  
  RESULTS
  Random biopsies were recommended in all patients but the decision to take biopsies was made by the treating urologist and hence performed in 326 out of 538 patients (61%), which revealed concomitant CIS in 47 patients(14%). Sixty out of 103 (58%) patients with pTaG3 or pT1G1-G3 tumours, in whom random biopsies were performed, received intravesical BCG compared with five out of 22 patients (23%) where random biopsies were not taken (p = 0.004). Moreover, 23 out of 103 patients (22%) with pTaG3 or pT1G1-G3 tumours in whom random biopsies were performed underwent radical cystectomy compared with none out of 22 patients (0%) without random biopsies (p = 0.013). The Cox proportional hazard ratio for death due to bladder cancer in patients with pTaG3 or pT1G1-G3 tumours among patients not having versus having undergone random biopsies was 2.5 (95% confidence interval 1.1-5.6).
  
  
  CONCLUSIONS
  Patients diagnosed in Stockholm in 1995 or 1996 with pTaG3 or pT1G1-G3 bladder tumours having undergone random bladder biopsies more frequently underwent BCG treatment and radical cystectomy and had higher cancer-specific survival than patients who did not undergo random biopsies.
authors: Department of Molecular Medicine and Surgery, Section of Urology, Karolinska University Hospital, Stockholm, Sweden.
authors: Andreas
authors: A
authors: Thorstenson
authors: Martin C
authors: MC
authors: Schumacher
authors: N Peter
authors: NP
authors: Wiklund
authors: Martin N
authors: MN
authors: Jonsson
authors: Per
authors: P
authors: Larsson
authors: Hans
authors: H
authors: Wijkström
authors: Erik
authors: E
authors: Onelöv
authors: Gunnar
authors: G
authors: Steineck
authors: Petra J
authors: PJ
authors: De Verdier
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000379:methods; D002278:Carcinoma in Situ / Q000473:pathology*; D002295:Carcinoma, Transitional Cell / Q000473:pathology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D009378:Neoplasms, Multiple Primary / Q000473:pathology*; D011446:Prospective Studies; D001749:Urinary Bladder Neoplasms / Q000473:pathology*