Balancing Follow-up and Interventions for Low-Grade Bladder Cancer

What is it about?

Low-grade non-muscleinvasive bladder cancer (NMIBC) patients require careful treatment schedules to avoid overtreatment. Urologists must balance follow-up and interventions. 75% of bladder cancers are NMIBC, with 50% being low-risk. Low-risk patients have a progression rate of <6% after 5 years. Active surveillance, chemoablation, and office fulguration are less invasive alternatives to transurethral bladder resection (TURB). The European Association of Urology guidelines remain cautious due to the limitations of these strategies. A retrospective study investigated high-grade recurrence patterns and risk factors in 184 patients with LG pTa NMIBC who underwent long-term follow-up according to EAU guidelines. After a median follow-up of 73 months, 15 patients (8%) experienced high-grade recurrence. The median time to high-grade recurrence was 41 months, and the high-grade recurrence-free survival was 91% at 96 months.

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Why is it important?

This research is important because it aims to investigate the high-grade recurrence patterns and related risk factors in a contemporary cohort of patients with low-grade (LG) primary Ta NMIBC, undergoing long and standardized follow-up. By understanding the risk factors associated with high-grade recurrence, urologists can make more informed decisions about treatment strategies and follow-up schedules, ultimately avoiding overtreatment while maintaining oncological safety. Key Takeaways: 1. The study investigates high-grade recurrence patterns and related risk factors in patients with low-grade primary Ta NMIBC. 2. A total of 184 patients were identified, with a median (interquartile range [IQR]) number of recurrences of 2 (1-3.5). 3. 52 patients (28%) underwent at least one course of intravesical therapy during the follow-up, predominantly with mitomycin (n 41, 22%). 4. After a median (IQR) follow-up of 73 (46-114) months, 15 patients (8%) had HG recurrence, including one patient who progressed to a MIBC. 5. The median time to HG recurrence was 41 (27-102) months, and the HG recurrence-free survival (RFS) was 98% (95 CI: 95-99%), 94% (95% CI: 89-97%), and 91% (95% CI: 84-95%) at 24, 72, and 96 months, respectively.