Actos and Bladder Cancer Process

Actos and Bladder Cancer : This is what is usually called a “false-positive” test result. The test was positive in a case where it seems that it should have been negative. Any medical test has a cer­tain false-positive rate (usually very low). The problem with a false-positive result with urine cytology is that there is no way to guarantee the absence of cancer. It is always possible that the cancer is there, but we have not been able to find it yet. Sometimes it can hide in places such as the ureters or kidney where we cannot see as well. Other times, especially with carcinoma in situ, the diseased areas look normal through the cysto- scope but actually harbor serious disease. Because of this, one should never ignore a positive cytology result. Close to 80% of patients with a positive cytology but a negative evaluation will eventually be found to have a urologic malignancy.

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The current recommendation for patients with a posi­tive urine cytology and a negative initial evaluation is to repeat the urine cytology 6 to 8 weeks later. Those patients with a negative cytology on the follow-up test do not need further evaluation. If the follow-up cytol­ogy is positive, however, careful evaluation should be undertaken, as most of these patients will eventually be found to have a malignancy. Your urologist may rec­ommend multiple small biopsies of the bladder to look for carcinoma in situ, a condition that is often associ­ated with positive cytology.

Although cytology has long been the gold standard for bladder cancer screening, including monitoring for recur­rences, it is far from perfect (see Question 33), and there is great interest in finding an even better test. Currently, at least four other markers are approved by the Food and Drug Administration (FDA), although none of them are clearly better than cytology. In addition to these four, many new tests are being developed. The four listed here are those that are currently available to patients. If you are considering a radical cystec­tomy, you want an individual who regularly performs that operation. A radical cystectomy is a complicated, time-consuming procedure that some urologists rarely or never perform. The old dictum “practice makes perfect” certainly applies here. Furthermore, if you are interested in the neobladder option for reconstruction of your urinary tract, you should make sure that the urologist is comfortable with that portion of the oper­ation. The neobladder adds complexity to the proce­dure for the surgeon, and not all urologists are well trained in this area. The urologist should know his or her own complication rate for the procedure and not just quote widely published rates for other surgeons. He or she should be comfortable and willing to discuss these rates with you.

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Cancer can be a frightening word and disease no matter how you look at it. You want a physician who understands your fears and concerns and who is willing to take the time to help you make your management decisions. There is no good measure for this, but trust your instincts at your first meeting with a new doctor. Sometimes you may feel that it is necessary to get a second opinion. You may have concerns about the treatment recommendations or may worry that there are other options that have not been presented. If you ever feel that you have not received enough informa­tion or that you are uncomfortable with the treatment recommendations from your urologist and/or oncolo­gist, then it is appropriate to seek a second opinion.

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Actos and Bladder Cancer