Contemporary management of superficial bladder cancer in the United States: A pattern of care analysis

Objectives. To assess the practice preferences among urologists treating superficial bladder cancer in the United States. Methods. We surveyed 226 urologists using a specially designed survey instrument. The type of practice, number of urologists in group practice, annual volume of patients with bladder cancer, and those treated with intravesical therapy were assessed. We also obtained information on the American Urological Association section and year of graduation from urology residency training. Results. Of the 226 contacted urologists, 105 (46%) returned a completed survey instrument. Seventeen percent were practicing in academic institutions and 63% were in independent community practice. Forty-five percent had graduated from urology training in or before 1985. Thirty-six percent were in small and 37% were in moderate-size groups. Thirty-five percent were treating a moderate number of patients with bladder cancer, and 44% were treating a large number of patients annually. Thirty-two percent had a moderate number and 40% had a large number of patients receiving intravesical therapy annually. Immunotherapy was preferred in patients at high risk of recurrence. Intravesical chemotherapy was preferred by many for immunotherapy failure. The type of practice and year of graduation were the factors most frequently affecting treatment choice. Conclusions. Practice preferences for the management of superficial bladder cancer are in general agreement with the American Urological Association Bladder Cancer Guidelines Panel recommendations. However, 81% of surveyed urologists were still reluctant to refer patients with high-grade Ta-T1 disease with failure after intravesical immunotherapy twice for more aggressive therapy such as cystectomy or radiotherapy.