Study Highlights Potential for Low-Intensity Surveillance AsOption for Some Patients with Non-Muscle Invasive Bladder Cancer

–Low-intensity cystoscopicsurveillance may be a viable option for patients with high-risk, non-muscle invasive bladder cancer (NMIBC), according to a new abstract from researchers in New Hampshire. This abstract will be presented to the media during a special session moderated by AUA Public Media Chair Sam Chang on May 15 at 8:30 a.m.In this retrospective cohort study of 1,542 veteransdiagnosed with high-risk NMIBC between 2005 and 2011 with follow up care through 2014, researchers at Dartmouth-Hitchcock reviewed the associationof low-intensity surveillance cystoscopies (one to five procedures) vs. high-intensity cystoscopies (six or more procedures) with frequency of transurethral resections, as well as risk of progression and bladder cancer deathin patients.

Patients who underwent low-intensity surveillance (520, or 33.7 percent) were found to have fewer transurethral resections than those with high-intensity surveillance (37 vs. 99 per 100 person-years). Stage of disease (non-invasive vs. invasive) was not found to be a confounding factor; no statistical difference was found between frequency or cystoscopic surveillance and risk of bladder cancer progression or death.

Patients undergoing low-intensity surveillance had a decreased risk of progression to invasive disease or death compared to the high-intensity group (19.3 percent vs. 31.4 percent at five years). Similarly, of the patients with non-invasive disease who underwent fewer cystoscopies. 5.7 percent had an increased risk of death at five years compared to 8.2 percentof patients with more aggressive surveillance protocols.

“The authors should be commended for their efforts to determine the most appropriate surveillance schedule for patients with non-muscle invasive bladder cancer.The findings are provocative, but every retrospective study is affected by selection bias,” Dr. Chang said. “I want to caution, as the authors themselves conclude, that their findings serve to justify a future clinical trial and should NOT guide current clinical practice.

 

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