Prolonging follow-up intervals for non-invasive bladder tumors: a randomized controlled trial

Considerable resources are devoted to the follow-up of patients with superficial bladder tumors. Traditionally these patients are evaluated every three months in the first year(s) after the primary resection. In a randomised controlled design we evaluated the consequences of doubling the follow-up intervals for patients with non-invasive bladder tumors (Ta) with none of the following risk factors: concomitant urothelial dysplasia, tumor grade > II, early recurrence. The patients were allocated to one of two follow-up regimens: Regimen I: follow-up every three months for the first two years and every six months in the third year, thereafter once a year. Regimen II: Every six months for the first year and once a year thereafter. At most of the follow-up visits the bladder was examined by transabdominal ultrasound. Cystoscopy was performed in all patients once a year. The data from the 97 patients were evaluable. Three patients in regimen I and 1 patient in regimen II progressed in grade and/or stage in the observed period. No patient died of his tumor disease. There was no difference with regard to recurrence, progression and tumor-related death between the two groups. The total number of follow-up visits in regimen II was reduced by 37.5% (P = 0.0016) compared to regimen I. The number of patients specific follow-up visits with a recurrent tumor present was increased by 65% (P = 0.0475). In the future we will follow this selected group of patients with non-invasive bladder tumors as described.