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      Female with bladder cancer: what and why is there a difference?

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          Abstract

          While men are at a considerable higher risk of developing urothelial carcinoma of the bladder (UCB), women present with more advanced disease stages and seem to experience unfavorable outcomes. Evaluating specific differences in the UCB incidence and outcomes between both genders in the non-muscle invasive, muscle-invasive or locally advanced and metastatic setting, as well as determining the underlying causes of disease, may allow optimizing treatment and improving the quality of urological care among both genders. In this review we summarize the best evidence and most recent findings on gender-specific differences in UCB incidence and outcomes. In addition, we present a comprehensive overview on established and potential reasons for differences in gender-specific UCB outcomes, including disparities in the pelvic anatomy, the diagnostic work-up, the modality and quality of treatment, the exposure to risk factors, the degradation of carcinogens as well as the sex-hormone signaling.

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          EAU guidelines on muscle-invasive and metastatic bladder cancer: summary of the 2013 guidelines.

          J. Alfred Witjes, Eva Comperat, Nigel Cowan … (2014)
          The European Association of Urology (EAU) guidelines panel on Muscle-invasive and Metastatic bladder cancer (BCa) updates its guidelines yearly. This updated summary provides a synthesis of the 2013 guidelines document, with emphasis on the latest developments. To provide graded recommendations on the diagnosis and treatment of patients with muscle-invasive BCa (MIBC), linked to a level of evidence. For each section of the guidelines, comprehensive literature searches covering the past 10 yr in several databases were conducted, scanned, reviewed, and discussed both within the panel and with external experts. The final results are reflected in the recommendations provided. Smoking and work-related carcinogens remain the most important risk factors for BCa. Computed tomography (CT) and magnetic resonance imaging can be used for staging, although CT is preferred for pulmonary evaluation. Open radical cystectomy with an extended lymph node dissection (LND) remains the treatment of choice for treatment failures in non-MIBC and T2-T4aN0M0 BCa. For well-informed, well-selected, and compliant patients, however, multimodality treatment could be offered as an alternative, especially if cystectomy is not an option. Comorbidity, not age, should be used when deciding on radical cystectomy. Patients should be encouraged to actively participate in the decision-making process, and a continent urinary diversion should be offered to all patients unless there are specific contraindications. For fit patients, cisplatinum-based neoadjuvant chemotherapy should always be discussed, since it improves overall survival. For patients with metastatic disease, cisplatin-containing combination chemotherapy is recommended. For unfit patients, carboplatin combination chemotherapy or single agents can be used. This 2013 EAU Muscle-invasive and Metastatic BCa guidelines updated summary aims to increase the quality of care and outcome for patients with muscle-invasive or metastatic BCa. In this paper we update the EAU guidelines on Muscle-invasive and Metastatic bladder cancer. We recommend that chemotherapy be administered before radical treatment and that bladder removal be the standard of care for disease confined to the bladder. Copyright © 2013 European Association of Urology. Published by Elsevier B.V. All rights reserved.
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            Recurrence of high-risk bladder cancer: a population-based analysis.

            Karim Chamie, Mark Litwin, Jeffrey Bassett … (2013)
            Patients with bladder cancer are apt to develop multiple recurrences that require intervention. The recurrence, progression, and bladder cancer-related mortality rates were examined in a cohort of individuals with high-grade non-muscle-invasive bladder cancer.
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              The effect of age and gender on bladder cancer: a critical review of the literature.

              Shahrokh F. Shariat, John P Sfakianos, B. H. Bochner … (2010)
              While patient age and gender are important factors in the clinical decision-making for treating urothelial carcinoma of the bladder (UCB), there are no evidence-based recommendations to guide healthcare professionals. We review previous reports on the influence of age and gender on the incidence, biology, mortality and treatment of UCB. Using MEDLINE, we searched for previous reports published between January 1966 and July 2009. While men are three to four times more likely to develop UCB than women, women present with more advanced disease and have worse survival rates. The disparity among genders is proposed to be the result of a differential exposure to carcinogens (i.e. tobacco and chemicals) as well as reflecting genetic, anatomical, hormonal, societal and environmental factors. Inpatient length of stay, referral patterns for haematuria and surgical outcomes suggest that inferior quality of care for women might be an additional cause of gender inequalities. Age is the greatest single risk factor for developing UCB and dying from it once diagnosed. Elderly patients face both clinical and institutional barriers to appropriate treatment; they receive less aggressive treatment and sub-therapeutic dosing. Much evidence suggests that chronological age alone is an inadequate indicator in determining the clinical and behavioural response of older patients to UCB and its treatment. Epidemiological and mechanistic molecular studies should be encouraged to design, analyse and report gender- and age-specific associations. Improved bladder cancer awareness in the lay and medical communities, careful patient selection, treatment tailored to the needs and the physiological and physical reserve of the individual patient, and proactive postoperative care are particularly important. We must strive to develop transdisciplinary collaborative efforts to provide tailored gender- and age-specific care for patients with UCB.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Transl Androl Urol
                Journal ID (iso-abbrev): Transl Androl Urol
                Journal ID (publisher-id): TAU
                Title: Translational Andrology and Urology
                Publisher: AME Publishing Company
                ISSN (Electronic): 2223-4691
                Publication date (Print and electronic): October 2016
                Publication date (Print): October 2016
                Volume: 5
                Issue: 5
                Pages: 668-682
                Affiliations
                [1 ]Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany;
                [2 ]Department of Urology, Medical University Vienna, Vienna, Austria
                Author notes

                Contributions: (I) Conception and design: A Soave, P Marks, M Rink; (II) Administrative support: SF Shariat, H Fajkovic, M Fisch; (III) Provision of study materials or patients: A Soave, P Marks, M Rink; (IV) Collection and assembly of data: A Soave, P Marks, M Rink; (V) Data analysis and interpretation: A Soave, P Marks, M Rink; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.

                [*]

                These authors contributed equally to this work.

                Correspondence to: Michael Rink, MD, FEBU. Associate Professor in Urology, Department of Urology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, D-20246 Hamburg, Germany. Email: m.rink@ 123456uke.de .
                Article
                Publisher ID: tau-05-05-668
                DOI: 10.21037/tau.2016.03.22
                PMC ID: 5071204
                PubMed ID: 27785424
                SO-VID: 5ec1f598-5a0e-423a-9cc0-7ca2f9f12fd6
                Copyright © 2016 Translational Andrology and Urology. All rights reserved.
                History
                Date received : 18 January 2016
                Date accepted : 28 February 2016
                Categories
                Subject: Review Article

                Keywords: urothelial carcinoma of the bladder (ucb),urinary bladder neoplasms,gender,sex,therapy,outcome,survival,surgery,chemotherapy,steroid hormones
                Data availability:
                Keywords: urothelial carcinoma of the bladder (ucb), urinary bladder neoplasms, gender, sex, therapy, outcome, survival, surgery, chemotherapy, steroid hormones

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