Check Cystoscopy Follow-up Practice for Low-Risk (pTa) Non-muscle Invasive Bladder Cancer in the United Kingdom The NICE or the European Guidelines?
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Abstract
Objectives: To identify the best practice policy and guideline for surveillance with check cystoscopies
follow up for low-risk pTa urothelial bladder tumour and to identify the recurrence rate and the progression rate of low-risk urothelial bladder tumour and how safe is it to discharge them at 1- versus 5-years of follow up.
Primary outcome: The primary goal is to assess both the rate of recurrence and rate of progression of low-risk Non-muscle Invasive Bladder Carcinoma (NMIBC) during the first 5-year after initial Trans-
Urethral Resection of Bladder Tumour (TURBT) and how safe is to discharge this class of group after one year versus five years of surveillance and compare it to previous reports.
Secondary outcome: To estimate the cost-effectiveness of a reduced follow-up scheme, if this is deemed
a safe practice to follow.
Methodology: It is a single centre, retrospective review of all low-risk NMIBC patients diagnosed with low-risk bladder tumors at our Trust between 2012 and 2014 from our local urological cancer multi-disciplinary team (MDT) registry and ensured a 5-year time-lapse from diagnosis. Histology grade and staging from the first TURBT, receiving of mitomycin within 24 hrs following the initial TURBT, the timing of cystoscopy follow-up, cystoscopy findings (evidence of recurrence), further procedures (bladder biopsy, fulguration or TURBT), histology of further procedures, recurrence rate and time from the first TURBT to discharge to primary care are reviewed and analysed.
Result: Our initial review revealed a high likelihood of recurrence (33.9%) in the low-risk NMIBC
patients after 12 months of being cancer free. It also demonstrated that there is further progression in (23.8%) of those who had a later recurrence despite being asymptomatic.
Conclusion: We would recommend a 5-year follow-up surveillance and further national collaboration to audit this patient subgroup to define a safe period of cystoscopic follow-up for these patients and bring
further evidence for NICE to build up their recommendations.
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References
2. Babjuk M, Burger M, Comperat E, et al. Guidelines on non-muscle invasive bladder cancer (Ta, T1 and CIS). In EAU Guidelines. 2019.
3. Flaig TW. New treatment options for patients with bladder cancer. J Nat Compr Cancer Net 2022; 20(5.5):570-572.
4. Ritch CR, Velasquez MC, Kwon D, et al. Use and validation of the AUA/SUO risk grouping for non-muscle invasive bladder cancer in a contemporary cohort. J Urol 2020; 203(3):505-511.
5. Holmäng S, Johansson SL. The nested variant of transitional cell carcinoma - A rare neoplasm with poor prognosis. Scand J Urol Nephrol 2001;35(2):102-105, DOI: 10.1080/003655901750170425
6. Borhan A , Reeder JE, O'Connell MJ, et al. Grade progression and regression in recurrent urothelial cancer. J Urol 2003 Jun;169(6):2106-9. doi: 10.1097/01.ju.0000067160.09881.45
7. Gofrit ON, Pode D, Lazar A, et al. Watchful waiting policy in recurrent Ta G1 bladder tumors. Eur Urol 2006;49(2):303-307.
8. Oosterlinck W. Clinical Management of Low-Grade Bladder Tumors. In: Bladder Tumors: Humana Press; 2011: 217-236.
9. Avritscher EB, Cooksley CD, Grossman HB, et al. Clinical model of lifetime cost of treating bladder cancer and associated complications. Urology 2006 Sep;68(3):549-53.
10. Langa KM, Fendrick AM, Chernew ME, et al. Out‐of‐pocket healthcare expenditures among older Americans with cancer. Value Health 2004;7(2):186-194.
11. Mariappan P and Smith G. A surveillance schedule for G1Ta bladder cancer allowing efficient use of check cystoscopy and safe discharge at 5 years based on a 25-year prospective database. J Urol 2005; 173(4):1108-1111.
12. Leblanc B, Duclos AJ, Bénard F, et al. 1999. Long-term follow-up of initial Ta grade 1 transitional cell carcinoma of the bladder. J Urol 1999;162(6):1946-1950.
13. Gunlusoy B, Ceylan Y, Degirmenci T, et al. The potential effect of age on the natural behavior of bladder cancer: Does urothelial cell carcinoma progress differently in various age groups? Kaohsiung J Med Sci 2016;32(5):261-266.