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Safety of active surveillance program for recurrent nonmuscle-invasive bladder carcinoma
Urology, 07/02/09

Hernandez V et al. - In a study to explore the experience with a group of pts with low-risk tumors included in an observation and monitoring program after diagnosis of recurrence, it was found that pts with recurrent, small (<1 cm), nonmuscle-invasive bladder tumors can be safely offered monitoring under an active surveillance protocol, with minimal risk of progression in either grade or stage, thus reducing the amount of surgical intervention pts might undergo.

Methods

A prospective cohort study was done in pts diagnosed with recurrent, nonmuscle-invasive bladder cancer maintained under an active surveillance protocol.
Inclusion criteria were papillary tumors with negative cytology findings, previous nonmuscle-invasive tumor (Stage pTa, pT1a), grade 1-2, size <1 cm, and number of tumors <5.
No symptomatic pts or those with carcinoma in situ or grade 3 tumors were included.
A retrospective analysis of a control group of pts with clinical characteristics similar to those of pts on active surveillance, but who underwent transurethral resection immediately after recurrence was diagnosed was also performed.

Results

Data from 64 pts (70 observation events) were analyzed.
Mean pt age was 66.7 yrs.
Median follow-up was 38.6 mos.
Median time pts remained in observation was 10.3 mos.
Tumor histologic features before observation were Stage pTa in 77.1%, Stage pT1a in 22.9%, grade 1 in 67.1%, and grade 2 in 23%.
After 10.3 mos, 93.5% of pts had not progressed in stage and 83.8% had not progressed in grade.
None of the pts experienced progression to muscle-invasive disease.
Comparison between rates of progression and control groups showed no statistically significant difference.

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