Safety of active surveillance program for recurrent nonmuscle-invasive bladder carcinoma

To report our experience with a select group of patients with low-risk tumors included in an observation and monitoring program after the diagnosis of recurrence.

We performed a prospective cohort study in patients diagnosed with recurrent, nonmuscle-invasive bladder cancer maintained under an active surveillance protocol. The 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 patients or those with carcinoma in situ or grade 3 tumors were included. A retrospective analysis of a control group of patients with clinical characteristics similar to those of the patients on active surveillance, but who underwent transurethral resection immediately after the recurrence was diagnosed was also performed.

The data from 64 patients (70 observation events) were analyzed. The mean patient age was 66.7 years. The median follow-up was 38.6 months. The median time patients remained in observation was 10.3 months. The 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 months, 93.5% of the patients had not progressed in stage and 83.8% had not progressed in grade. None of the patients experienced progression to muscle-invasive disease. A comparison between the rates of progression in the study and control groups showed no statistically significant difference.

Patients with recurrent, small (<1 cm), nonmuscle-invasive bladder tumors can be safely offered monitoring under an active surveillance protocol, with a minimal risk of progression in either grade or stage, thus reducing the amount of surgical intervention they might undergo throughout their life.