Low-intensity cystoscopic surveillance may be a viable option for patients with high-risk, non–muscle invasive bladder cancer, according to data from a paper presented to the media during a special session moderated by the American Urological Association (AUA) on May 15. The research was also published by Rezaee et al in The Journal of Urology.
Methods
In this retrospective cohort study of 1,542 veterans diagnosed with high-risk non–muscle invasive bladder cancer between 2005 and 2011 with follow-up care through 2014, researchers at Dartmouth-Hitchcock reviewed the association of 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 death in patients.
Findings
Patients who underwent low-intensity surveillance (n = 520, 33.7%) were found to have fewer transurethral resections than those with high-intensity surveillance (37 vs 99 per 100 person-years). Stage of disease (noninvasive 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% vs 31.4% at 5 years). Similarly, of the patients with noninvasive disease who underwent fewer cystoscopies, 5.7% had an increased risk of death at 5 years compared to 8.2% of patients with more aggressive surveillance protocols.
The study authors concluded, “Patients with high-risk non–muscle invasive bladder cancer undergoing low- vs high-intensity cystoscopic surveillance underwent fewer transurethral resections but did not experience an increased risk of progression or bladder cancer death. These findings provide a strong rationale for a clinical trial to determine whether low-intensity surveillance is comparable to high-intensity surveillance for cancer control in high-risk non–muscle invasive bladder cancer.”
Sam Chang, MD, MBA
“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," said special session moderator and AUA Public Media Chair Sam Chang, MD, MBA. "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.”
Disclosure: For full disclosures of the study authors, visit auajournals.org.
