Gender-related differences in clinical and pathological characteristics and therapy of bladder cancer

Objective: To confirm the very high male:female ratios previously observed among Spanish bladder cancer patients and to assess gender differences in tumoral characteristics, diagnostic procedures, and treatment in a large series of consecutive bladder cancer patients. Patients and Methods: All newly diagnosed bladder cancer patients (n = 615) in 17 Spanish hospitals, between 1997-2000, were included. Information was collected both through personal interviews to patients and from medical records using a structured form. Results: Seventy-six percent of tumours were superficial. The male:female ratio was 6.7 and it was similar for superficial and infiltrating tumours. Women were older than men at the diagnosis of bladder cancer (68.2 +/- 9.4 years versus 65.7 +/- 9.7 years, p = 0.01). Ten percent of superficial tumours in women, versus 3% in men, were classified as other histological types (p = 0.008). TIGIII tumours were more frequent among men (17% versus 7%,p = 0.047). On the other hand, women were more likely to present with 0a-stage tumours (48.6% versus 35.5%, p = 0.04), multiple tumours (50% versus 29%, trend test: 0.005), multi-centric tumours (54% versus 38%, p = 0.019), and larger infiltrating masses (5.2 cm versus 3.8 cm, p = 0.03) than men. Among Oa-stage tumours, only 23% of women compared to 54% of men received transurethral resection (TUR) alone (p = 0.002). Women were almost five-fold more likely to receive additional therapies to TUR (p = 0.004) after adjusting for age, geographical area, stage, tumoral size, nuclear grade, and multiplicity. Conclusion: The study confirms the very high male:female ratio of bladder cancer in Spain. We found substantial differences in the pathological characteristics of tumours from men and women. There was a tendency for women to receive more frequently non-standard, more aggressive, therapy than men. (C) 2002 Elsevier Science B.V. All rights reserved.