Long-term oncological outcomes of an active surveillance program in recurrent low grade Ta bladder cancer

Over the last 2 decades, there has been a major increase in active surveillance (AS) as a therapeutic alternative in urological tumors regarded to be of low risk. Owing to the findings of significant clinical outcomes in our series, this report presents an update of our AS program in patients with recurrent non-muscle-invasive bladder tumor. The objective was to confirm the oncological long-term safety of this protocol and to determine possible variables associated with progression.

Cohort of patients included in AS between 1999 and 2014.

recurrent papillary tumors, previous pTa-pT1, G1-G2, shorter than 1cm, and fewer than 5 tumour sites.

prior G3, CIS (carcinoma in situ), or positive-result cytology. All patients underwent close monitoring with flexible cystoscopy every 3 to 4 months for the first 2 years. After this time, follow-ups were conducted every 6 months, alternating between cystoscopy and ultrasound. Urinary cytology test was performed at all visits.

In all, 252 AS periods in 186 patients were studied, with a median follow-up of 6 years. Out of all periods, 203 (80.6%) underwent active treatment. After remaining under observation, 86.4% had not progressed in stage, and 79.3% in grade. Of these patients, 4 experienced progression to T2; all of them were previously T1G2.

AS in a high-selectivity group of patients with recurrent non-muscle-invasive bladder tumor is feasible and oncologically safe in the long term. Patients with previous history of T1 should not be included in AS protocols even when very small recurrences are diagnosed.