Check Cystoscopy Follow-up Practice for Low-Risk (pTa) Non-muscle Invasive Bladder Cancer in the United Kingdom

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 deemeda 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.