What are the NCCN recommendations for follow-up after radical cystectomy for bladder cancer?

Updated: Feb 23, 2021
  • Author: Kara N Babaian, MD, FACS; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Answer

For follow-up after a radical cystectomy for muscle-invasive bladder cancer, NCCN recommendations are as follows [1] :

  • Imaging: For the first two years, patients should undergo computed tomography (CT) or magnetic resonance imaging (MRI) urography (imaging of upper tracts plus axial imaging of abdomen and pelvis) every 3-6 months. Chest x-ray or CT every 3-6 months or fluorodeoxyglucose positron emission tomography/CT (FDG PET/CT) (category 2B) is recommended only if metastatic disease is suspected. In years 3 through 5, patients should have abdominal/pelvic CT or MRI annually. Chest  x-ray annually or FDG PET/CT (category 2B) is recommended only if metastatic disease is suspected. After year 5, patients should have annual ultrasound to look for hydronephrosis; after more than 10 years, imaging is needed only if clinically indicated.
  • Blood tests: Kidney function testing (electrolytes and creatinine) is recommended every 3-6 months. A complete blood cell count (CBC) and comprehensive metabolic panel (CMP) should be performed every 3-6 months in patients who received chemotherapy. Liver function tests (LFTs) should be performed every 3-6 months. In year 2 through year 5, patients should have annual kidney function testing, LFTs, and vitamin B12 assays. After year 5, patients should have annual monitoring of vitamin B12 levels.
  • Urine tests: For the first two years following radical cystectomy, patients should have urine cytology every 6-12 months; consider urethral wash cytology every 6-12 months for patients with high-risk disease (eg, postitive urethral margin, multifocal CIS, prostatic urethal invasion). Cytology should be performed at the time of cystoscopy if bladder in situ. 

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