What are the guidelines on the surveillance for recurrent bladder cancer?

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

Answer

Periodic cystoscopy is unanimously recommended by all guidelines with early initial cystoscopy at 3-4 months after treatment and cytology with subsequent cystoscopy for patients at intermediate- or high-risk. Recommendations for risk-stratified surveillance schedules vary, with none of the guidelines offering high-level evidence in support of a specific schedule. Uniquely, the NICE guidelines recommend that patients with low-risk NMIBC who are free from recurrence at 12 months may be discharged from routine urologic follow-up. [17] The interval recommended by each organization is summarized in the table below. [1, 2, 18, 19, 20, 17]  

Table. Risk-stratified surveillance recommendations (Open Table in a new window)

Risk  Organization Year Cystoscopy interval
Low-risk NCCN 2018

after initial cystoscopy, at 3 and 12 months; annually for years 2-5; then as clinically indicated

  AUA/SUO 2016 6-9 months after initial cystoscopy, annually for years 2-5; then in the absence of recurrence, continued surveillance should be based on shared-decision making between the patient and clinician
  EUA 2016 9 months after initial cystoscopy, then annually for 5 years. Consider stopping after 5 years without recurrence.
  CUA 2015 annually after initial cystoscopy
  ESMO 2014 every 3–6 months based on risk during the first 2 years, and every 6–12 months thereafter
  NICE 2015 3 months and 12 months after diagnosis. Do not offer routine cystoscopy follow-up after 12 months
       
Intermediate-risk NCCN 2018

after initial cystoscopy, at 3, 6 and 12 months; every 6 months for year 2; annually for years 3-5;

then as clinically indicated

  AUA/SUO 2016 after initial cystoscopy, every 3-6 months for 2 years, 6-12 months for years 3 and 4, and then annually thereafter
  EUA 2016 surveillance interval between low and high risk recommendation
  CUA 2015 every 3-4 months for first 2 years; every 6 months for years 3-4; annually thereafter
  ESMO 2014 every 3–6 months based on risk during the first 2 years, and every 6–12 months thereafter
  NICE 2015 3, 9, 18 months and then annually therafter. Consider discharging to PCP after 5 years of disease free follow-up
       
High-risk NCCN

2018

every 3 months for first 2 years; every 6 months for years 3-5; annually for years 5-10;

then as clinically indicated

  AUA/SUO 2016 every 3-4 months for first 2 years; every 6 months for years 3-4; annually thereafter
  EUA 2016 every 3 months for first 2 years; every 6 months for years 3-5; annually thereafter
  CUA 2015 every 3-4 months for first 2 years; every 6 months for years 3-4; annually thereafter
  ESMO 2014 every 3–6 months based on risk during the first 2 years, and every 6–12 months thereafter
  NICE 2015 every 3 months for first 2 years; every 6 months for years 3-4; annually thereafter
       
Upper tract evaluation All   every 1–2 years for high-risk NMIBC

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