Death from bladder cancer is uncommon. Superficial bladder tumors (very early bladder cancer) lining the wall of the bladder are common. The superficial tumors have the capacity to turn into dangerous tumors that invade into the muscle surrounding the bladder and spread everywhere from there. Which ones will do this? Can one intervene to prevent this? How much surgery is necessary? These questions remain, even in this era of genomic medicine. A group of investigators from Great Britain have taken another stab at this. Published in the Journal of Clinical Oncology in December, 2020 is an article in which the authors attempted to begin to answer this question. Click here for the abstract of the article. Ask Dr. Stark for the full article by filling out the form to the right. The authors identified over 200 patients with high-risk superficial bladder cancer. High risk was defined by the appearance under the microscope, depth of invasion, size of the tumor and the presence of more than one tumor. Only 50 of the patients agreed to enter the study, in which patients would receive either drugs into the bladder to try to control the tumors, or complete removal of the bladder together with surrounding organs. Patients had to agree to sign up for the study before knowing which path they would go down. Tough sell. Anyway 25 patients were supposed to get bladder removal, but 5 refused. 25 were supposed to get drug; 2 refused. At the end of a year. the surgery patients did a little bette, but the numbers were so small that a conclusion could not be drawn. Dr. Stark weighs in: this was too small a study with too short a follow up for us to learn anything. It does show that answering this question will be very difficult. Maybe we need a new path, such as comprehensive genetic analysis of these tumors to look at risk of death.