Active surveillance for low-risk bladder cancer

• Published in: Urologic oncology 2014, Vol.32 (1), p.33.e7-33.e10
• Main Authors: Tiu, Albert, M.B.B.S, Jenkins, Lawrence C., M.D, Soloway, Mark S., M.D
• Format: Article
• Language: English
• Subjects: Active surveillance; Bladder cancer; Cost; Cystoscopy; Disease Progression; Humans; Low risk; Medical Oncology - methods; Neoplasm Recurrence, Local - diagnosis; Neoplasm Recurrence, Local - pathology; Quality of Life; Risk; Transurethral resection of bladder tumor; Treatment Outcome; Urinary Bladder Neoplasms - diagnosis; Urinary Bladder Neoplasms - epidemiology; Urinary Bladder Neoplasms - surgery; Urology; Urology - methods
• ISSN: 1078-1439; 1873-2496
• DOI: 10.1016/j.urolonc.2012.12.003

Abstract Background Most newly diagnosed bladder cancers present as non–muscle invasive bladder cancer (NMIBC). NMIBC is a heterogeneous disease with varying treatment options, follow-up schedules, and oncologic outcomes. We sought to review the role of active surveillance for low risk bladder cancer in the literature. Methods A PubMed search was performed using the following keywords: active surveillance, low risk, bladder, transurethral resection of bladder tumor, cost, and quality of life. Relevant articles were reviewed and utilized. Results Low-risk bladder cancer—defined as pTa low-grade papillary tumors—is the type of NMIBC with the most favorable oncologic outcome and which almost never progresses to muscle invasive disease or metastasizes. Bladder cancer has the highest per patient treatment costs of all cancers. One of the reasons is the high rate of recurrence. Patients with low-grade bladder tumors often experience a recurrence after primary transurethral resection. Many patients undergo multiple resections in the hospital. Conclusions Appropriately selected patients with recurrent low-risk bladder cancer could be managed with either office fulguration or cystoscopic surveillance. Active surveillance for patients with low-risk bladder cancer avoids or delays the surgical and anesthetic risks of a TURBT, thus optimizing quality of life without compromising the patient's risk of cancer progression.