Investig Clin Urol.  2016 Jun;57(Suppl 1):S4-S13. 10.4111/icu.2016.57.S1.S4.

Active surveillance for nonmuscle invasive bladder cancer

• Miyake M
• Fujimoto K
• Hirao Y

• KMID: 2426512
• DOI: http://doi.org/10.4111/icu.2016.57.S1.S4

Abstract

Nonmuscle invasive bladder cancer (NMIBC) is known to be a heterogeneous malignancy that requires varying treatment modalities and follow-up schedules. Low-grade Ta papillary tumors are categorized as low-risk NMIBC because of their favorable prognosis. There is an expanding movement that overdiagnosis and overtreatment should be avoided considering the economic impact and the patients' quality of life. It has been over 10 years since the initial assessment of active surveillance for low-risk NMIBC suggested its feasibility and safety. However, urologists are still unfamiliar with this treatment option, which can be ideal in appropriately selected patients. In this review article, we focus on active surveillance for low-risk NMIBC and discuss the evidence and rationale for this treatment option. There are several issues to resolve in order to advocate active surveillance as a standard option in selected patients. A specific follow-up protocol including intervals of cystoscopy, urine cytology, urine markers, and other radiographic examinations need to be optimized and validated. Finally, we integrate the available data into the follow-up strategy and propose a new surveillance protocol for active surveillance of recurrent low-risk bladder cancer.

Keyword

Local neoplasm recurrence; Risk assessment; Urinary bladder neoplasms; Watchful waiting

MeSH Terms

Animals
Disease Models, Animal
Evidence-Based Medicine/methods
Humans
Neoplasm Invasiveness
Neoplasm Recurrence, Local/diagnosis
Population Surveillance/methods
Prognosis
Urinary Bladder Neoplasms/*diagnosis/epidemiology/pathology
Watchful Waiting/*methods

Figure

• 

  Fig. 1 The proposed algorithm for active surveillance of nonmuscle invasive bladder cancer. TURBT, transurethral resection of bladder tumor; NMIBC, nonmuscle invasive bladder cancer; CIS, carcinoma in situ.

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