Can the burden of follow-up in low-grade noninvasive bladder cancer be reduced by photodynamic diagnosis, perioperative instillations, imaging, and urine markers?

PURPOSE OF REVIEW: Reduce the burden of follow-up for patients and healthcare providers in noninvasive bladder cancer (NIBC). The evolution of intraoperative tumor detection, imaging modalities, urinary markers, and intravesical instillation regimens as a possibility to improve tumor eradication, enhance noninvasive tumor monitoring and thus to reduce costs is reviewed. RECENT
FINDINGS: On the basis of current evidence, the recurrence and progression of patients with NIBC can significantly be improved by fluorescence-guided transurethral resection and perioperative chemoinstillation. Virtual cystoscopic modalities based on computed tomography or magnetic resonance imaging as well as a combination of urine biomarkers, which improve the sensitivity of conventional urine cytology, has the potential to reduce discomfort and pain associated with conventional cystoscopy. Recent meta-analyses have furthermore demonstrated that risk-adapted instillation regimens for immediate, induction and maintenance therapy using immuno-instillation and chemoinstillation therapy improve significantly recurrence-free and progression-free survival rates.
SUMMARY: Emerging technologies in the field of tumor visualization in combination with urinary markers and effective instillation regimens can significantly reduce the risk of recurrence and progression in the long-term whilst providing less patient discomfort and simplifying the follow-up in patients of NIBC.