Gender-related Characteristics of Bladder Cancer Treatment
Gender-related Characteristics of Bladder Cancer Treatment
The most frequent cancer of the urinary tract is the bladder cancer (BC), in Italy its
 incidence reaches the 7% of all the new diagnosis of cancer, accounting for the fifth cause
 of death in the western countries, overall 140.000 new cases per year in Europe. In the year
 2017, the Italian association for medical oncology (AIOM) recorded in our country about
 21.700 new diagnosis of BC men and 5.300 in women. This data show not only a relevant gender
 disparity on the disease incidence (in 5th to 7th decade male incidence: 11-12% of all new
 diagnosis of cancer versus 1% in women) but also on the outcomes of treatment. Overall, the
 30% of all the new diagnosis have a muscle-invasive (MIBC) onset, the female gender suffer a
 correlation with a more advanced disease at the time of first diagnosis. As a consequence,
 men have lower BC-related mortality when compared to women (p<0,001). This discrepancy in the
 mortality rate has been investigated by many authors, resulting in the evidence that female
 gender suffers higher risks, especially during the first two-years after the radical
 cystectomy. A comprehensive explanation has not been formulated yet, but a multiplicity of
 cofactors, including variations in the hormone receptors and tumor biology as well as the
 different anatomy between male and female, have been identified as potentially relevant.
 Another important issue in the pre-operatory management of female patients with BC is the
 misleading interpretation of hematuria. It seems to directly correlate with the evidence that
 women suffer a more advanced stage at diagnosis, and this element has been withheld in the
 list of relevant risk factors for prognosis. Nevertheless, a thorough analysis of their
 effect will only be possible in the future, as well-designed prospective and randomized
 clinical trials are currently not available.

 A part from the preoperatory disparity, it has also been described that men are more
 frequently candidates to an orthotopic urinary diversion, leading female patients to an
 irreversibly altered perception of personal integrity and body image, namely to a lower
 quality of life after radical cystectomy. The female anatomy has been considered as a
 limitation to continence recovery, resulting in preoperative counselling more frequently
 against in favor of ileal conduit or not-continent urinary diversions.
Inclusion Criteria:

 -  Patient undergoing radical cystectomy since September 2016 December 2020

 -  Development of bladder cancer confirmed histologically

 -  Written informed consent

 Exclusion Criteria:

 • Lack of clinical and prognostic data on selected patients