الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
• In a guideline centered approach, we enrolled two groups of patients;
group A; include 15 patients who were classified as having highest risk NMIBC tumors after initial (diagnostic) complete TURBT. Those patients were offered immediate (upfront) RC.
group B; include 23 patients who were classified as BCG non responders; 14 patients were BCG refractory and 9 patients were BCG relapsing. Those patients were offered early RC. Decision were made after complete TURBT for recurrence during the follow up period of those patients which showed high grade NMIBC disease.
• The mean age was 62.40 ± 7.06, 57.65±7.63 years in group A, and group B respectively. All patients enrolled in this study were males. Performance status of studied patients was at least ECOG 2.
• 17 patients (44.7%) were upstaged to MIBC after RC (5 patients from the highest risk/ upfront RC group “33.33%” and 12 patients from the BCG non responders/ early RC group “52.17%”
• The incidence of LNs metastasis was 18.4% (7 patients) (2 patients from the highest risk/ upfront RC group “13.33%” and 5 patients from the BCG non responders/ early RC group “21.74%”.
• There were no statistically significant difference between both patient categories/ type of RC and upstaging as well as incidence of LNs metastasis (p= 0.254 and 0.681 respectively).
• In univariate and multivariate logistic regression analyses for all clinical and pathological criteria of patients with highest risk tumors (group A patients) before RC as regarding upstaging after RC; there were statistically significant association between upstaging after RC and age, time lapse between first diagnosis and RC, and gross prostatic urethral infiltration, (p = 0.035, < 0.001, and 0.004 respectively). However, multivariate logistic regression analysis of the variables with significant association showed that these variables cannot predict the presence of upstaging in RC specimens.
• MRI of the urinary bladder was done in all patients of group A (highest risk patients) in order to comment on radiological tumor microstaging as well as LNs status. MRI of the urinary bladder was able to predict accurate local staging of bladder cancer in 13 patients (86.67%), while it was overstaging in 2 patients (13.33%).
• There were statistically significant correlation between radiological staging of MRI of the urinary bladder and histopathological staging of RC specimens (p < 0.001). Multivariate logistic regression analysis showed that MRI microstaging (p = 0.01) can predict the presence of upstaging in RC specimens.
• Multivariate logistic regression analyses showed that MRI tumor microstaging can predict the presence of tumor upstaging after RC.