Know the gender differences in bladder cancer

Even after diagnosis, female patients with bladder cancer continue to suffer worse outcomes than males following definitive treatment. While it has been proposed that advanced stage presentation in women may be to blame, this does not fully explain differences in overall survival. An analysis of 5-year survival between men and women with bladder cancer found that women fared worse across all stages (Urology 2000; 55:368-71). This would suggest that gender continues to play a role even after diagnosis.

The evidence for nonmuscle-invasive bladder cancer is mixed and somewhat limited. One single-institution series suggests that women were less likely to receive intravesical therapy for nonmuscle-invasive disease, but larger population cohorts have failed to demonstrate this (Urol Oncol 2014; 32:52.e1-9; Br J Cancer 2013; 108:1534-40).

Several studies have examined the use of treatment modalities and associated outcomes in women with muscle-invasive bladder cancer. An analysis of SEER data that examined the use of radical cystectomy or radiotherapy in patients with muscle-invasive bladder cancer revealed that while men were more likely to receive radiotherapy, there were no differences in the use of radical cystectomy between men and women (J Urol 2003; 170:1765-71). 

Similarly, it has been demonstrated that female patients do not experience significant differences in surgical margin status and lymph node count at the time of cystectomy (Eur Urol 2014; 66:913-9). Outcomes regarding cancer-specific survival following cystectomy have unfortunately been conflicting. While older series demonstrated female gender as an independent risk factor for worse cancer-specific survival, newer series suggest the gender gap may be closing (Gend Med 2012; 9:481-9). While more studies are needed to confirm this new trend, it is encouraging. This may in part be due to heightened awareness of historical disparities in the diagnosis and treatment of bladder cancer in women.

For more information on the disparities: Gender disparities in bladder cancer management