What’s known on the subject? and What does the study add? Circulating tumour cells (CTC) have prognostic relevance for patients with different metastatic carcinomas. Detection of CTC using the CellSearch system has also been reported in bladder cancer, but mainly in patients with metastatic disease. This is the largest report demonstrating that detection of CTC in non‐metastatic bladder cancer patients is feasible using the CellSearch system. Presence of CTC may be predictive for early systemic disease. OBJECTIVE: To prospectively detect and evaluate the biological significance of circulating tumour cells (CTC) in patients with bladder cancer, especially in those patients with non‐metastatic, advanced bladder cancer (NMABC). PATIENTS AND METHODS: Between July 2007 and January 2009, blood samples of 50 consecutive patients with localized bladder cancer and five patients with metastatic disease scheduled for cystectomy were prospectively investigated for CTC. Peripheral blood (7.5 ml) was drawn before cystectomy. Detection of CTC was performed using the USA Food and Drug Administration‐approved CellSearch ^TM system. Data were compared with the clinical and histopathological findings. RESULTS: CTC were detected in 15 of 50 patients (30%) with non‐metastatic disease and five of five patients with metastatic disease. The overall mean number of CTC was 33.7 (range: 1–372; median: 2). In non‐metastatic patients, the mean number of CTC was 3.1 (range: 1–11; median: 1). Except for a univariate association between CTC with vessel infiltration ( P = 0.047), all other common clinical and histopathological parameters did not reveal a significant correlation with CTC detection. A median 1‐year follow up was available for 53 patients (96.4%). Ten out of 19 preoperatively CTC‐positive patients died as a result of cancer progression. CTC‐positive patients showed significantly worse overall ( P = 0.001), progression‐free ( P < 0.001) and cancer specific survival ( P < 0.001) compared to preoperatively CTC‐negative patients. CONCLUSION: This is the largest study demonstrating that detection of CTC in NMABC patients is feasible using the CellSearch ^TM system. Our findings suggest that the presence of CTC may be predictive for early systemic disease.

While men are at a considerable higher risk of developing urothelial carcinoma of the bladder (UCB), women present with more advanced disease stages and seem to experience unfavorable outcomes. Evaluating specific differences in the UCB incidence and outcomes between both genders in the non-muscle invasive, muscle-invasive or locally advanced and metastatic setting, as well as determining the underlying causes of disease, may allow optimizing treatment and improving the quality of urological care among both genders. In this review we summarize the best evidence and most recent findings on gender-specific differences in UCB incidence and outcomes. In addition, we present a comprehensive overview on established and potential reasons for differences in gender-specific UCB outcomes, including disparities in the pelvic anatomy, the diagnostic work-up, the modality and quality of treatment, the exposure to risk factors, the degradation of carcinogens as well as the sex-hormone signaling.