Misread Biopsy Leads to Delayed Recognition of Urothelial Carcinoma and Bladder Removal

I am an expert in bladder cancer. I have performed over 1400 cystectomies, and am nationally and internationally recognized for my expertise in both early (non-muscle-invasive) as well as muscle-invasive disease. I have been in practice for 26 years, and bladder cancer treatment constitutes about 80% of my clinical practice. I am currently Professor and Director of Urologic Oncology at a major Midwestern medical center.

It sounds like this patient was likely treated for presumed prostatitis. However, it is known that bladder cancer can also give irritative symptoms and can be misdiagnosed as prostatitis early on in the evaluation. Prostatitis may have negative urine cultures but tends to improve with antibiotics. On the other hand, hematuria, gross or microscopic, nearly always requires a urologic evaluation including cytology, cystoscopy, and imaging (typically a CT scan). It is highly unusual that bladder biopsies would be lost. Inaccurate pathological staging, on the other hand, is not that infrequent, whereby one pathologist, often community-based and not specializing in genitourinary pathology, either fails to see muscle invasion or calls it when it is not there. This occurs in my own university-based practice, about 10-15% of the time when I see patients with bladder cancer as second opinions.