- A low-intensity cystoscopic surveillance approach to follow-up patients with high-risk, nonmuscle invasive bladder cancer (NMIBC) after surgery appears feasible; however, randomized trials are warranted before incorporating it into practice.
Why this matters
- Patients with NMIBC need to undergo surveillance cystoscopy after transurethral resection and possible intravesical therapy for assessment of disease recurrence over time.
- Retrospective cohort study including 1542 patients (age, >65 years) from US Department of Veterans Affairs diagnosed with high-risk NMIBC between 2005 and 2011 and followed up through 2014.
- Patients were categorized into:
- Low-intensity surveillance: 1-5 cystoscopies.
- High-intensity surveillance: ≥6 cystoscopies.
- Funding: None disclosed.
- With low- vs high-intensity surveillance:
- Fewer transurethral resections: 37 vs 99 per 100 person-years (P<.001>
- No significant difference in risk for bladder cancer death at 5 years:
- Cumulative incidence (CIn): 8.4% vs 9.1% (P=.61).
- No increased risk (CIn) for bladder cancer death at 5 years with:
- Ta: 5.7% vs 8.2% (P=.24).
- T1: 10.2% vs 9.1% (P=.58).
- Decreased risk for progression to invasive disease (T1/T2) or death at 5 years:
- CIn: 19.3% vs 31.3% (P=.002).
- Findings may be subject to unmeasured confounding.
- The potential influence of adjunct testing/imaging on surveillance cystoscopy practices was not assessed.