Active surveillance for non-muscle-invasive bladder cancer: fallacy or opportunity?. Issue 5 (22nd September 2022)

• Record Type: Journal Article
• Authors: von Deimling, Markus; Pallauf, Maximilian; Bianchi, Alberto; Laukhtina, Ekaterina; Karakiewicz, Pierre I.; Rink, Michael; Shariat, Shahrokh F.; Pradere, Benjamin
• Is Part Of: Current opinion in urology. Volume 32:Issue 5(2022)
• Page Start: 567
• Page End: 574
• Publication Date: 2022-09-22
• Subjects: active surveillance -- non-muscle-invasive bladder cancer -- personalized medicine -- Ta low-grade -- urinary biomarkers; Urology -- Periodicals; Review Literature -- Bibliography; Review Literature -- Periodicals; Male Urogenital Diseases -- Bibliography; Male Urogenital Diseases -- Periodicals; Female Urogenital Diseases -- Bibliography; Female Urogenital Diseases -- Periodicals; Urologic Diseases -- Bibliography; Urologic Diseases -- Periodicals; Periodicals; 616.6005
• DOI: 10.1097/MOU.0000000000001028
• Languages: English
• ISSNs: 1473-6586

Abstract

Abstract : Purpose of review: This review aims to analyze the current place of active surveillance (AS) in non-muscle-invasive bladder cancer (NMIBC). Recent findings: A growing body of evidence suggests that AS protocols for pTa low-grade (TaLG) NMIBC are safe and feasible. However, current guidelines have not implemented AS due to a lack of high-quality data. Available studies included pTa tumors, with only one study excluding pT1-NMIBC. Inclusion/exclusion criteria were heterogeneously defined based on tumor volume, number of tumors, carcinoma in situ (CIS), or high-grade (HG) NMIBC. Tumor volume <10 mm and <5 lesions were used as cut-offs. Positive urinary cytology (UC) or cancer-related symptoms precluded inclusion. Surveillance within the first year consisted of quarterly cystoscopy. AS stopped upon the presence of cancer-related symptoms, change in tumor morphology, positive UC, or patient's request. With a median time on AS of 16 months, two-thirds of the patients failed AS. Progression to muscle-invasive bladder cancer (MIBC) was rare and occurred only in patients with pT1-NIMBC at inclusion. Summary: AS in NMIBC is an attractive concept in the era of personalized medicine, but strong evidence is still awaited. A more precise definition of patient inclusion, follow-up, and failure criteria is required to improve its implementation in daily clinical practice.