Long‐term outcomes and cost savings of office fulguration of papillary Ta low‐grade bladder cancer

Abstract

ObjectivesRecurrent non‐muscle invasive bladder cancer (NMIBC) which carries a considerable economic burden, is primarily managed by transurethral resection of bladder tumor (TURBT). Office‐based fulguration (OF) under local anesthesia for small, recurrent, pTa low grade (LG) NMIBC is an attractive alternative to TURBT, avoiding the cost and risk of procedure and anesthesia but is not widely used. Long‐term oncological data of patients managed with OF are lacking.Material and methodsOut of 521 patients with primary TaLG, this retrospective study included 270 patients who underwent OF during follow‐up for recurrent, small, papillary low grade appearing tumours at a University Center (University Health Network, University of Toronto, Canada). We assessed the cumulative incidence of cancer specific mortality (CSM) and disease progression (to muscle‐invasive BC or metastases) as well as possible direct cost savings.ResultsIn 270 patients with recurrent TaLG treated with OF, mean age was 64.9 (SD 13.3) years, 70.8% were men and 60.3% had single tumours. The mean number of OF procedures per patient was 3.1 (SD 3.2, range 1‐22). Median follow‐up was 10.1 years (IQR 5.8−16.2). Patients also underwent a mean of 3.6 (SD 3.0) TURBTs during follow‐up in case of numerous or bulkier recurrence. 44.4% of patients never received intravesical therapy. Ten‐year incidence of CSM and progression were 0% and 3.1% (95%CI: 0.8‐5.4%), respectively. Direct cost savings in Ontario were estimated at $6994.14 per patient over the study follow up.ConclusionsThis study supports that properly selected patients with recurrent, apparent TaLG NMIBC can be safely managed with office fulguration under local anesthesia with occasional TURBT for larger or numerous recurrent tumours, without compromising long‐term oncological outcomes. This approach could generate substantial cost‐saving to health care systems, is patient‐friendly and could be adopted more widely.