1121 High Grade Bladder Cancer in A 28-Year-Old Male: The Burden Of Recurrence

Bladder cancer is the seventh commonest cancer worldwide to affect men. The known risk factors for bladder cancer are smoking, occupational exposure to chemicals, male sex. We report a case of non-muscle invasive bladder cancer in a 28–year–old male smoker who works as a hotel manager. No exposure to occupational dyes and other risk factors. Bladder cancer can occur at any age, however data on bladder cancer in the young like in this patient is uncommon in the literature. He presented with painless gross hematuria and had a flexible cystoscopy done which revealed a 2-3cm papillary growth just lateral to the right ureteric orifice with a narrow stalk and ultrasound of the urinary tract showed no abnormal finding. Urgent transurethral resection of the tumour was done. The tumor was completely resected, and biopsy confirmed a high grade non muscle invasive G3pTa transitional cell carcinoma. Computed tomography scan of the chest showed no evidence of metastasis. MRI of the bladder confirmed tumor grading to be T2aN0M0.The patient had intravesical mitomycin post operatively. Repeat flexible cystoscopy showed a suspicious recurrence and he underwent a rigid cystoscopy and biopsy which confirmed a low grade G2pTa transitional cell carcinoma recurrence. Currently, he is being considered for regular surveillance cystoscopies versus intravesical Bacillus Calmette-Guerin therapy. There are slightly conflicting recommendations from NICE and EAU. The goal of this paper is to recount our experience and review the literature on the management of recurrent high grade, non-muscle invasive bladder cancer.