Is cystoscopy follow-up protocol safe for low-risk bladder cancer without muscle invasion?
Ugur Yucetas1, Erdogan Aglamis2, Huseyin Aytac Ates3, Kemal Behzatoglu4, Erkan Erkan1, Mahmut Gokhan Toktas1, Erdinc Unluer5
1 Department of Urology, Health Sciences University, Istanbul Training and Research Hospital, Istanbul, Turkey
2 Department of Urology, Health Sciences University, Elazig Training and Research Hospital, Elazig, Turkey
3 Department of Urology, Gebze Fatih State Hospital, Kocaeli, Turkey
4 Department of Pathology, Acibadem Atakent Hospital, Istanbul, Turkey
5 Department of Urology, Florence Nightingale Hospital, Istanbul, Turkey
Huseyin Aytac Ates,
Department of Urology, Gebze Fatih State Hospital, Osman Yilmaz Mah., Gebze 41400, Kocaeli
Source of Support: None, Conflict of Interest: None
Objective: 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.
Materials and Methods: 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.
Results: 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.
Conclusion: 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.