Monitoring

Lifelong risk of another de novo bladder tumor developing requires monitoring, primarily by cystoscopy.

Nonmuscle-invasive bladder cancer

Monitoring is based on the risk category.

  • Low-risk: patients have cystoscopy at 3 months because early recurrence is a poor prognostic sign.[47][149]​ Subsequent frequency and duration of cystoscopy and imaging follow-up is informed by the individual patient's risk and necessitates shared decision-making.[40][47] Discontinuation of cystoscopy or a less invasive method of surveillance should be considered.[47] Recurrence after 5 recurrence-free years is low among patients with low-risk disease.

  • Intermediate risk: recommendations vary. American Urological Association guidelines suggest upper tract imaging at one to two year intervals for patients with intermediate-risk bladder cancer.[40] European Association of Urology guidelines recommend that intermediate-risk patients receive cystoscopy and urine cytology at 3 months, then every 6 months for 2 years, followed by annual cystoscopy for up to 10 years.[43][47]​​​ Upper tract imaging should be considered every 1-2 years.

  • 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 in the absence of recurrence.[40] Upper tract imaging should be considered every 1-2 years.[40]

Muscle-invasive disease

Involves abdominal/pelvic/chest CT or MRI (every 6-12 months for 2-3 years, then annually) and laboratory assessment (every 3-6 months for 2-3 years, then annually).[111]​ Upper tract imaging, FDG-PET/CT, and cytology may also be indicated.[43]​

Regular cystoscopy is required for muscle-invasive disease treated with bladder-sparing modalities (every 3 months for 2 years, then every 6 months for 2 years, then annually until at least year 10).[43][53] 

Monitoring for metastatic disease includes regular chest/abdominal/pelvic CT (every 3-6 months, and if new symptoms or clinical changes occur) or FDG-PET/CT and blood tests, with cystoscopy, upper tract imaging, and urine cytology as clinically indicated.[43] ​

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