Adequacy of Tumor Staging after Laser Treatment of Superficial Transitional Cell Carcinoma of the Bladder

The ability to stage adequately tumors treated by a laser has been questioned because tissue is not retrieved by the usual methods for histologic examination. At our center, 121 patients with superficial (stage Ta or T₁) transitional cell carcinoma of the bladder were treated with a neodymium:YAG laser. All patients had a history of transitional cell carcinoma of the bladder, a tumor that was 2 cm or smaller, and a lesion which, on gross visual examination at cystoscopy, appeared to be superficial and papillary. Biopsies were not routinely obtained either before or after treatment. Of 41 patients who have developed tumor recurrence with a minimum follow-up of 6 months, 35 (87%) had superficial papillary recurrent lesions including all seven of the patients who developed a recurrence at the site of laser therapy. Three patients have developed muscle invasive tumors at 9, 17, and 46 months after laser treatment, all in areas of the bladder other than the site of laser treatment. Significant understaging with neodymium:YAG laser treatment of superficial bladder cancer is not a clinical problem if appropriate patient selection criteria are used.