Transitional cell carcinoma of the bladder in patients under 40 years of age.

There are conflicting reports about the natural history and prognosis of bladder tumours in patients under 40 years of age. A review of 156 patients younger than 40 treated at our Department between 1960 and 1991 with transitional cell carcinoma of the bladder revealed that 89.1% had superficial (Ta/T1) disease and the remaining 10.9% presented with invasive disease. Slightly more than half of the patients with superficial disease had multiple tumours. The follow-up of 97 patients over a period of 12-372 months revealed that there was a recurrence rate of 10.3% and 38.4% for Ta and T1 tumours, respectively (p < 0.01). Further analysis comparing patients under 30 to those between 30 and 40 years revealed recurrence rates of 7.5% and 22%, respectively (p < 0.05). Progression rates for Ta and T1 tumours are 3.5% and 19.3% (p < 0.05). In the invasive disease group 8 patients were lost for follow-up, 2 died of the disease and the remaining 7 are alive, with a mean follow-up of 3.6 years. We conclude that while transitional cell carcinoma of the bladder in patients under 30 behave less aggressively, the behaviour of the disease in patients 30 to 40 years old is similar to the older age group and should be monitored closely, especially when risk factors for recurrence and progression are present.