EAU 2017: Debate - Do we need to follow-up in low grade bladder tumor after 12 months?-Yes (EAU Guidelines)

London, England (UroToday.com) In this session, a debate ensued between two guidelines for the surveillance of low risk bladder tumors. Specifically, what is the best follow-up protocol for low risk tumors that do not recur? Is it 1 year as the NICE guidelines would suggest or 5 years as the EAU guidelines would suggest? Professor Burger was tasked with defending the EAU guideline recommendations of 5 years of total follow-up.

He began by demonstrating that most patients rate cystoscopy as a relatively painless experience. Thus, there is not a moral imperative to cease surveillance at 1 year. He then argued that a 1 year follow-up strategy will miss many recurrences. In fact, approximately 20-30% of recurrences occur between 1 and 5 years. In contrast, only 8% of patient who have not had a previous recurrence will develop one after 5 years. Thus, the logical time frame to stop surveillance remains after 5 years, but not after only 1 year.

Interestingly, Professor Burger then argued that ignoring surveillance after 1 year increases the probability of future symptomatic presentations. In a non-muscle invasive bladder cancer active surveillance (AS) cohort, approximately one-third of patients discontinued AS due to bothersome hematuria. Thus, there is a very real risk of symptomatic re-presentation if surveillance is discontinued after 1 year.

Guidelines set boundaries and do not set a rigid, prescribed treatment course. The EAU guidelines recommend that patients with low risk tumors should undergo cystoscopy at 3 months. If follow-up remains negative, subsequent cystoscopy is advised 9 months later and then annually for 5 years.

Speaker: M. Burger, Regensburg, DE

Written by: Benjamin T. Ristau, MD, SUO Fellow, Fox Chase Cancer Center, Philadelphia, PA.

at the #EAU17 -March 24-28, 2017- London, England