Which alternative surveillance strategies for recurrent bladder cancer are being investigated?

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

Answer

Artificial neural networks using various tumor markers similar to those described by Parekattil et al may be more cost effective for detecting recurrence and progression than the current screening protocol of cystoscopy and conventional cytology at predetermined intervals. [7] Using more effective markers may allow scheduling of cystoscopy on a more logical and targeted schedule than is currently the default.

Nonlinear surveillance strategies have been shown in at least one model to actually decrease the time to detection of tumor recurrence while optimizing the utilization of resources. [16] In nonlinear surveillance, the follow-up schedule is determined by patients’ individual risk profiles, with longer intervals between visits for low-risk patients and shorter intervals for high-risk patients. The risk profile is based on the patient's prior recurrence rate and tumor stage and grade.

A fresh look at surveillance strategies is in order based on the lack of evidence on which current standards are based and on new findings regarding the ability to predict cancer recurrence using neural networks, prediction models, and improved diagnostic tests, including molecular diagnostic evaluations. As this process progresses, the conventional surveillance protocol will likely change. Using tumor stage and grade in conjunction with improved surveillance methods, resources may be focused on patients at risk of recurrence and progression.

Specific concepts likely to help focus surveillance in the near future include improved endoscopic techniques that can identify otherwise imperceptible malignancy and molecular diagnostic tests that can identify malignant change prior to anatomic transformation. However, until such time, cystoscopy in conjunction with some form of cytology (either conventional or molecular cytology, ie, FISH) is likely to remain the mainstay in surveillance at currently accepted intervals.


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