Mark S. Soloway, MD

High-grade urothelial cancer ofthe bladder is not only relativelycommon but unfortunately,is frequently lethal. These tumorsare often diagnosed when thetumors have already invaded the wallof the bladder. Even when they arediagnosed at a time when they areconfined to the mucosa or lamina propria,patients may not respond to abladder-preservation approach. Oftena radical cystectomy with urinary diversionis either not offered at all or notconsidered until the cancer has invadeddeep into the muscularis propria andlocal treatment fails.

Radical prostatectomy is not only the most common operation performed by most urologic oncologists, but also probably now represents the most common open operative procedure performed by all urologists in the United States. Much of this dramatic increase is due to the use of prostate-specific antigen (PSA) as a method for early diagnosis. My own experience is not unusual, in that approximately 50% of my male patients who underwent a radical prostatectomy last year had clinical stage T1c prostate cancer, meaning that the digital rectal exam was normal. The diagnostic biopsy was performed because of an elevated PSA.