Standard management for recurrent low-grade non-muscle-invasive bladder cancer (LG-NMIBC) often involves a substantial treatment burden, which is not justified by the relatively indolent course of the disease, prompting a need for de-intensification strategies. Active surveillance (AS) is an alternative approach aimed at reducing overtreatment in selected patients. However, the broader adoption of AS is hindered by a lack of standardized protocols for patient selection, monitoring and intervention. To address this gap, we conducted an international, two-round Delphi consensus among 51 bladder cancer experts to establish foundational statements for the use of AS. Consensus was achieved on 20 statements, providing clear recommendations for terminology; inclusion and exclusion criteria; follow-up monitoring; and exit criteria. This Delphi consensus provides the first expert-driven framework to standardize the clinical application of AS for LG-NMIBC. These statements could guide current clinical practice and unify the design of future trials.
Nature reviews. Urology. 2026 Apr 01 [Epub ahead of print]
Roberto Contieri, Paolo Gontero, Rodolfo Hurle, Luca Afferi, Simone Albisinni, Marek Babjuk, Alison Birtle, Peter Black, Maurizio Brausi, Max Bruins, Otakar Čapoun, Albert Carrion, James Catto, Ananya Choudhury, Alessia Cimadamore, Eva Comperat, Siamak Daneshmand, David D'andrea, Francesco Del Giudice, Jose Luis Domínguez Escrig, Patrick Hensley, Wojciech Krajewski, Ekaterina Laukhtina, Roger Li, Fredrik Liedberg, Yair Lotan, Gautier Marcq, Paramananthan Mariappan, Andrea Mari, Alberto Martini, Alexandra Masson Lecomte, Richard Meijer, Maria Carmen Mir, Keiichiro Mori, Marco Moschini, Hugh Mostafid, Micheal O'Donnell, Joan Palou, Valeria Panebianco, Sisto Perdonà, Sima Porten, Sarah Psutka, Michael Rink, Morgan Roupret, Thomas Seisen, Mark Soloway, Viktor Soukup, Gary Steinberg, Arnulf Stenzl, Jeremy Yc Teoh, Karl Tully, Toine van der Heijden, Bas W G van Rhijn, Alfred Witjes, Evanguelos Xylinas, Ashish M Kamat, Benjamin Pradere, Laura S Mertens
Department of Urology, Istituto Nazionale Tumori di Napoli, IRCCS 'G. Pascale', Naples, Italy., Division of Urology, Department of Surgical Sciences, AOU Città della Salute e della Scienza at Molinette Hospital and University of Turin, Turin, Italy., Department of Urology, Humanitas Clinical and Research Institute IRCCS, Milan, Italy., Department of Urology, Kantonsspital Aarau, Aarau, Switzerland., Urology Unit, Department of Surgical Sciences, Tor Vergata University Hospital, University of Rome Tor Vergata, Rome, Italy., Department of Urology, Teaching Hospital Motol, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic., University of Manchester, Manchester, UK., Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada., Department of Urology, Hesperia Hospital, Modena, Italy., Department of Urology, Zuyderland Medisch Centrum, Sittard/Heerlen, The Netherlands., Department of Urology, General University Hospital and 1st Faculty of Medicine, Charles University Praha, Prague, Czechia., Department of Urology, Vall Hebron Hospital, Autonomous University of Barcelona, Barcelona, Spain., Division of Clinical Medicine, School of Medicine & Population Health, University of Sheffield, Sheffield, UK., Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK., Institute of Pathological Anatomy, Department of Medicine, University of Udine, Udine, Italy., Department of Pathology, Medical University Vienna, Vienna, Austria., Department of Urology, USC Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA., Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria., Department of Maternal Infant and Urologic Sciences, "Sapienza" University of Rome, Policlinico Umberto I Hospital, Rome, Italy., Department of Urology, Instituto Valenciano de Oncologia, Valencia, Spain., Department of Urology, University of Kentucky College of Medicine, Lexington, KY, USA., University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, Wroclaw, Poland., Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA., Division of Urological Research, Department of Translational Medicine, Lund University, Skåne University Hospital, Malmö, Sweden., University of Texas Southwestern, Dallas, TX, USA., Department of Urology, CHU Lille, Lille UniversityUniversity, Lille, France., Edinburgh Bladder Cancer Surgery (EBCS), Department of Urology, Western General Hospital, Edinburgh, UK., Unit of Oncologic Minimally-Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy., Department of Urology, University of Cincinnati College of Medicine, Cincinnati, OH, USA., Department of Urology, Hôpital Saint-Louis AP-HP, Université Paris Cité, Paris, France., Department of Oncological Urology, University Medical Center Utrecht, Utrecht, The Netherlands., Department of Urology, Mount Sinai Icahn School of Medicine, Elmhurst/Queens Hospitals, New York, NY, USA., Department of Urology, Jikei University School of Medicine, Tokyo, Japan., Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy., Department of Urology, Stokes Centre for Urology, Royal Surrey Hospital, Guildford, UK., Department of Urology, University of Iowa, Iowa City, IA, USA; Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, USA., Department of Urology, Fundació Puigvert, Barcelona, Spain., Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy., Department of Urology, University of California San Francisco, San Francisco, CA, USA., Department of Urology, Marienkrankenhaus Hamburg, Hamburg, Germany., GRC n°5, Predictive Onco-Urology, Ap-Hp, Hôpital Pitié-Salpêtrière Urology, Sorbonne Université, Paris, France., Urologic Oncology, Memorial Physician Group, Division of Urology, Memorial Healthcare System, Aventura, FL, USA., Department of Urology, Rush University Medical Center, Chicago, IL, USA., Department of Urology, Eberhard-Karls-University, Tübingen, Germany., Department of Surgery, S.H. Ho Urology Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China., Department of Urology and Neurourology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany., Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands., Department of Surgical Oncology (Urology), Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands., Department of Urology, Bichat Claude Bernard Hospital, Paris University, Paris, France., Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA., Department of Urology, La Croix Du Sud Hospital, Quint-Fonsegrives, France., Department of Surgical Oncology (Urology), Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands. .