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Updated: Apr 24, 2026
Magnetic Resonance Imaging Assessment of Carcinogen-induced Murine Bladder Tumors
Published on: March 29, 2019
Surveillance patterns in non-muscle-invasive bladder cancer across risk groups: a real-world analysis
Lisa M C van Hoogstraten1,2, Sita H Vermeulen3, Jasper P Hof3,4
1Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands.
Objective:
To provide insight into real-world surveillance practices for patients with low-risk (LR), intermediate-risk (IR), and (very) high-risk (HR) non-muscle invasive bladder cancer (NMIBC).
Patients And Methods:
Cystoscopy surveillance patterns were analysed using real-world data from two population-based cohort studies in the Netherlands, comparing practices to guideline recommendations by risk group. As bladder cancer-related symptoms may prompt diagnostic investigations beyond routine follow-up, we evaluated the occurrence of such symptoms and the use of various diagnostics including cystoscopy in a subset of patients with available data.
Results:
In total, 2791 primary and recurrent tumours were included in the analyses. Among patients with LR NMIBC, 37.6% were monitored more intensively than recommended. The average number of cystoscopies in the first follow-up year was 1.3 (range 0-4). IR NMIBCs were generally monitored in accordance with guideline recommendations. However, adherence declined over the years following diagnosis, dropping from 78.1% to 59.3%. The proportion of patients with IR NMIBCs who were monitored less than recommended increased from 21.7% to 39.8%. Most HR NMIBCs (88.2%) were monitored less than recommended, though adherence improved over time. In-depth analysis of 204 tumours revealed that next to cystoscopy, cytology was frequently employed, increasing with risk group (LR: 50.0%, IR: 52.3%, HR: 88.9%). Imaging (25-65%) and biopsies (25-85%) were also commonly performed. Surveillance patterns varied especially among IR NMIBCs. Symptoms were reported in approximately one third of bladder tumours during follow-up but did not appear to affect surveillance patterns.
Conclusion:
Our findings demonstrate substantial deviations from recommended NMIBC surveillance practices, with cystoscopy overuse in LR disease and underuse in HR cases. Surveillance of IR NMIBC was particularly heterogenous, using varying diagnostic investigations. These insights highlight the need to refine NMIBC surveillance schedules to improve patient outcomes and optimise healthcare resource allocation.
