Is cystoscopy follow-up protocol safe for low-risk bladder cancer without muscle invasion?

The applicability of cystoscopy follow-up protocol that is indicated for low-risk nonmuscle-invasive bladder cancer (NMIBC) in the guidelines was investigated for our population.

Patients who underwent transurethral resection with a diagnosis of primary bladder tumor in our clinic within 10 years with low grade of pathology pTa and follow-up periods of at least 5 years were retrospectively reviewed. Fifty-one patients (39 males and 12 females) who were diagnosed with a low-risk NMIBC, had no recurrence at the 3-month control cystoscopy, and followed up for the first 2 years on 3-month basis with cystoscopy were included in the study.

The mean age of the patients was 57.37 ± 12.21 years (range: 29-80 years), and the mean duration of recurrence was 25.76 ± 32.45 months. In the cystoscopy follow-ups of 51 patients, up to the 6th month, a total of 12 (24%); up to the 9th month, a total of 21 (41%); up to the 12th month, a total of 30 (59%); up to the 15th month, a total of 36 (71%); up to the 18th month, a total of 36 (71%); up to the 21st month, a total of 39 (77%); and up to the 24th month, a total of 41 (80%) patients were reported to have recurrence. In the case of patients with no recurrence at the 9th month cystoscopy, it was determined that 50% of the patients had recurrence in the first 6 months and 67% in the first 2 years.

The majority (80%) of recurrences in low-risk NMIBC occurred in the first 2 years. If the follow-up protocol described in the guidelines had been applied, patients with relapses would have a delay of at least 6 months of diagnosis. Therefore, even if there is no recurrence in the low-risk NMIBC at the 3rd and 9th months, it may be more appropriate to follow the cases in the first 2 years with follow-up cystoscopy every 3 months.

Urology annals. 2019 Nov 07 [Epub]

Ugur Yucetas, Erdogan Aglamis, Huseyin Aytac Ates, Kemal Behzatoglu, Erkan Erkan, Mahmut Gokhan Toktas, Erdinc Unluer

Department of Urology, Health Sciences University, Istanbul Training and Research Hospital, Istanbul, Turkey., Department of Urology, Health Sciences University, Elazig Training and Research Hospital, Elazig, Turkey., Department of Urology, Gebze Fatih State Hospital, Kocaeli, Turkey., Department of Pathology, Acibadem Atakent Hospital, Istanbul, Turkey., Department of Urology, Florence Nightingale Hospital, Istanbul, Turkey.