What is included in the surveillance for recurrent bladder cancer following radical cystectomy?

Updated: Sep 10, 2019
  • Author: David A Levy, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Answer

Answer

A group from the University of Texas MD Anderson Cancer Center retrospectively reviewed their post–radical cystectomy surveillance protocol for 382 patients and concluded that a stage-specific approach was most appropriate. [13] With a median follow-up of 38 months, 25% of patients experienced recurrences, with a median time to recurrence of 12 months. The 4 most common sites of recurrence (in decreasing order of incidence) were the lung, pelvis, bone, and liver. Seventy-four percent of recurrences were asymptomatic, and 43 of the 72 asymptomatic recurrences were detected with chest radiography or liver function serum tests.

Only 5% of patients with pT1 disease had subsequent metastases, and all were identified with chest radiography or liver function tests. Among 10 patients who were found to have asymptomatic intra-abdominal recurrences based on CT scan findings, 9 had pT3 disease. Patients with pT2 and pT3 disease had recurrence rates of 20% and 40%, respectively. All recurrences in patients with pT2 or pT3 disease occurred within 24 months.

Based on these findings, the group recommended that surveillance should include the following:

  • History

  • Physical examination

  • Chest radiography

  • Liver function tests

  • Alkaline phosphatase assessment

The group recommended scheduling surveillance according to the patient’s disease stage, as follows:

  • pT1 disease - Annually

  • pT2 disease - Every 6 months for 3 years, then annually

  • pT3 disease - As with pT2 disease, but starting at 3 months, with CT scanning at 6, 12, and 24 months

All patients with transitional cell carcinoma (TCC), particularly those at higher risk of recurrence (eg, because of distal ureteral involvement at cystectomy, multiple recurrent bladder tumors, carcinoma in situ [CIS]), should undergo upper tract radiographic studies every 1-2 years.


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