Introduction: Northern Ontario's economy is built on forestry, transshipment, and manufacturing industries such as textile, steel, pulp, and paper. Moreover, Northern Ontario is the transshipment point of agriculture products across Canada. Northern Ontario is one of the leading mining regions for nickel, copper, uranium, zinc, gold, platinum, and silver. These factors may be putting population in Northern Ontario at a theoretically higher risk for exposure to bladder cancer carcinogens.
This study aimed to investigate the clinical and pathological characteristics of patients with de novo MIBC who underwent radical cystectomy in Northern Ontario.
Methods: This is a retrospective cross-sectional study of patients with de novo T2 MIBC who underwent radical cystectomy over a 2-year-period in Thunder Bay Regional Health Sciences Centre. Clinical and pathological characteristics of Trans Urethral Resection of Bladder Tumors and cystectomy specimens were analyzed.
Results: The mean age of the patients was 67 ± 8.8 years. Those aged under 60 years accounted for 27.1% of the sample. Based on final pathological results, upstaging was noted in 59.3%. Thirty-six percent had node-positive disease. Prostate adenocarcinoma was incidentally discovered in 34% of patients. Significant high-grade prostate cancer was found in 50% of patients. thirty four percent of patients had their surgery delayed for more than 12 weeks, mostly to receive neoadjuvant chemotherapy (NAC).
Younger patients (aged=60 years) had a higher prevalence of pathological upstaging (68.7% vs. 45.8%), as well as a higher chance of positive lymph nodes (37.5% vs. 34.9%), whereas older patients (Age>60) had a higher rate of incidental prostate cancer (34.9% vs. 31.3%).
patients that had NAC had a significantly less chance for upstaging on final pathology (P=0.001), regardless of the delay to surgery.
Conclusions: The high prevalence of younger ages (less than 60), a high rate of upstaging, the presence of high-grade incidental prostate cancer, and lymph node positives in clinical T2 de novo MIBC in Northern Ontario, warrants further investigation of potential causes and risk factors at individual, public, and population health levels in the region. Delay to cystectomy beyond 12 weeks because of neoadjuvant chemotherapy did not cause adverse pathological outcomes.
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