Urothelial dysplasia concomitant with bladder tumours: a determinant for future new occurrences in patients treated by full-course radiotherapy.

Concomitant urothelial dysplasia has been shown to predict new tumour occurrences after successful transurethral surgery of primary invasive bladder tumours. Of 114 patients with invasive bladder tumours treated by radiotherapy alone, 32 patients had complete primary tumour response and mucosal biopsies taken at preselected sites during initial cystoscopy. 10 of these patients had concomitant carcinoma-in-situ; in 7 new invasive tumours occurred 9-24 months after completion of radiotherapy. 4 of 9 patients with concomitant dysplasia grade-II also showed new invasive tumour growth. No new tumours developed in 13 patients without concomitant urothelial dysplasia who were followed for 9-75 months. Thus, the presence of concomitant carcinoma-in-situ in patients treated by radiotherapy predicts new invasive tumour growth, whereas its absence favours a very good prognosis. Patients with carcinoma-in-situ concomitant with invasive bladder tumours are not suitable for full-course radiotherapy as the only treatment.