Surveillance for Non-Muscle-Invasive Bladder Cancer

Follow-up after transurethral resection of bladder tumor (TURBT) for non-muscle-invasive bladder cancer (NMIBC) is necessary because of the significant risk of recurrence and progression. Cystoscopy remains the standard method for follow-up. When the first follow-up cystoscopy at 3 months after TURBT is negative, the following cystoscopies are traditionally repeated every 3 months for a period of 2 years, then every 6 months until the end of the fifth year, and yearly thereafter. This approach can now be tailored depending on individual risk of recurrence and progression. Low-risk patients can be discharged from cystoscopic follow-up after being free of recurrence for 5 years. In patients with a history of high-risk NMIBC including carcinoma in situ, urinary cytology should be used as an adjunct to cystoscopy with lifelong bladder follow-up and yearly upper tract imaging. Currently, urine markers have no adequate evidence-based role in the follow-up of NMIBC. A follow-up regimen for intermediate-risk patients is less clearly definable. It should be between low- and high-risk regimens according to the current guidelines. In summary, surveillance strategies should be individualized based on the risk of cancer recurrence at the bladder and extravesical sites.