Re : defining progression in nonmuscle invasive bladder cancer : it is time for a new, standard definition

We are in agreement with Lamm et al regarding the need for a new standard definition to describe progression of nonmuscle invasive bladder cancer (NMIBC). We, too, recognized that defining a state of progression before the development of muscle invasion would be a useful tool for clinical trials of patients with NMIBC. Consequently in 2005 we went through a similar process when writing the protocol for the West Midlands (United Kingdom) Bladder Cancer Prognosis Programme (BCPP, incorporating SELENIB [Selenium and Vitamin E Trial in Non-Muscle Invasive Bladder Cancer]), defining progression as “a recurrence with an increase in tumor grade from 1/2 to grade 3, or an increase in TNM stage, or the new occurrence of carcinoma in situ (CIS) in a bladder previously free from such lesions, or the new occurrence of multiple tumors following resection of a solitary tumor, or the need for a cystectomy because of refractory disease.”1 Clearly there are many similarities between our definition of progression for the purposes of BCPP/SELENIB and that proposed by Lamm et al, and we support their rationale and endeavor