Monitoring

Lifelong risk of recurrence necessitates monitoring, primarily by cystoscopy.

Monitoring of non-muscle-invasive bladder cancer is premised on risk category.

  • Low-risk: patients have cystoscopy at 3 months because early recurrence is a poor prognostic sign.​​[21][61]​​[188]​​​​​​ Subsequent cystoscopy is recommended at 12 months and annually thereafter.[21][60][61]​​​​ After 5 years, frequency and duration of cystoscopy follow-up is informed by the individual patient's risk and necessitates shared decision-making.​[61][60]​​​​ Discontinuation of cystoscopy or a less invasive method of surveillance should be considered.[21] Recurrence after 5 recurrence-free years is low among patients with low-risk disease.

  • Intermediate risk: recommendations vary. Following cystoscopy and urine cytology at 3 months, National Comprehensive Cancer Network guidelines recommend repeat testing at 6 months, then every 6 months for 2 years, followed by annual cystoscopy up to year 5.[61] American Urological Association guidelines suggest cystoscopy and urinary cytology every 3-6 months for 2 years, then every 6-12 months for years 3 and 4, and then annually, with shared decision-making determining frequency after 5 years.[60] Upper tract imaging may be considered every 1-2 years.[60]

  • High-risk: patients have cystoscopy and urine cytology every 3 months for 2 years, then every 6 months for years 3 and 4, then annually until year 10 in the absence of recurrence.[60][61]​ Upper tract imaging should be considered every 1-2 years.[60][61]

Muscle-invasive disease

Follow-up after cystectomy involves:[61]

  • CT or MR urography and CT chest (or chest x-ray) every 3-6 months, and consideration of urine cytology every 6-12 months, for 2 years.

  • After 2 years, annual abdominal/pelvic CT or MRI and /chest CT (or chest x-ray) until year 5, then annual renal ultrasound until year 10.

  • Blood tests (FBC, metabolic panel, renal and liver function tests) every 3-6 months for 1 year, then annual renal and liver function tests (and vitamin B12 as needed) until year 5.

Follow-up after bladder-sparing therapy involves:[61]

  • Cystoscopy every 3 months for 2 years, then every 6 months for 2 years, then annually until at least year 10.

  • CT or MR urography and CT chest (or chest x-ray) every 3-6 months, and urine cytology every 6-12 months, for 2 years. After 2 years, annual abdominal/pelvic CT or MRI and /chest CT (or chest x-ray) until year 5.

  • Blood tests every 3-6 months for 1 year.

  • If metastatic disease is suspected, FDG-PET/CT is recommended.

For patients with histopathological subtypes, follow-up should take into account the increased risk for recurrence.[61][189]​​

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