Active surveillance is safe in small low grade and stage superficial bladder cancer

13.11.2018

Patients with small low-grade, low stage recurrent papillary bladder tumours could benefit from an active surveillance protocol with no significant risk of pathological progression to muscle-invasive cancer.

Low-risk (LR) non-muscle-invasive bladder cancers (NMIBCs) represent the majority of newly diagnosed bladder cancers in Western countries. Local recurrence after primary treatment remains high, with a very low progression rate to muscle-invasive bladder cancer (MIBC): the 5-yr stage and/or grade progression for pTa low-grade (LG) tumours is 0.8%, and even after recurrence the chance of progressing to MIBC does not exceed 6%.

Although transurethral resection of bladder tumour (TURBT) is the gold standard for NMIBC treatment, it has a risk of complications such as bleeding, bladder perforation, and urethral stricture, especially in some patients such as the elderly and subjects with severe comorbidities. Thus, in 2003 Soloway et al, emphasising the statement "first of all, do no harm" and the need to avoid overtreatment and associated morbidity, suggested an active surveillance (AS) program as a safe and valid alternative to TURBT. Since 2003, several studies have reported AS results demonstrating that it is feasible and effective in a subset of patients with recurrent LG NMIBC.

The results of a recent published study, confirm that AS might be a reasonable strategy in patients presenting with small LG pTa/pT1a recurrent papillary bladder tumours. Focusing on pathological evaluation, the authors found that approximately 30% of patients deemed to have AS failure did not harbour any neoplastic lesion. These data, although surprising, seem to strengthen the role of AS in a selected population with recurrent NMIBC.

Reference

Hurle et al. Pathological Outcomes for Patients Who Failed To Remain Under Active Surveillance for Low-risk Non-muscle-invasive Bladder Cancer: Update and Results from the Bladder Cancer Italian Active Surveillance Project. Eur Urol Oncol 2018 1(5):437-442

https://www.sciencedirect.com/science/article/pii/S258893111830066X?via%3Dihub


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