N von Landenberg1, N Benderska-Söder2, E Bismarck2, K Kernig3, E Erne4, P J Goebell5, B J Schmitz-Dräger6,7. 1. Marien Hospital Herne, Klinik für Urologie, Ruhr-Universität Bochum, Herne, Deutschland. 2. Urologie 24, Mommsenstr. 22 (Pavillon C), 90491, Nürnberg, Deutschland. 3. Urologische Klinik, Universität Rostock, Rostock, Deutschland. 4. Urologische Klinik, Eberhard-Karls Universität, Tübingen, Deutschland. 5. Klinik für Urologie und Kinderurologie, Friedrich-Alexander-Universität, Erlangen, Deutschland. 6. Urologie 24, Mommsenstr. 22 (Pavillon C), 90491, Nürnberg, Deutschland. bernd_sd@yahoo.de. 7. Klinik für Urologie und Kinderurologie, Friedrich-Alexander-Universität, Erlangen, Deutschland. bernd_sd@yahoo.de.
Abstract
BACKGROUND: Follow-up for non-muscle invasive bladder cancer (NMIBC) is a challenge for urologists that has not been finally resolved. The intensity of follow-up is based on the recurrence and progression behavior of the tumor as well as the patient's individual situation. MATERIALS AND METHODS: The following article focuses on the current data situation, the valid German S3 guideline and the available instruments for the detection of relapses and progression, taking into account tumor stages and degree of malignancy. RESULTS: Urethrocystoscopy, imaging and urine cytology are generally recommended, but the recommendations appear to be too extensive in the case of so-called intermediate risk profiles. Depending on the situation, urine markers could optimize follow-up, although results from prospective randomized studies are still pending. CONCLUSIONS: The current follow-up of NMIBC is invasive, carries the risk of side effects and increases costs. In the absence of scientific evidence, recommendations for follow-up for NMIBC are naturally based on expert opinion. In the opinion of the authors, overdiagnosis is currently taking place particularly in patients with an intermediate risk profile. The first prospective, marker-based studies are ongoing and will be helpful in the near future to improve the data situation relevant to urological practice.
BACKGROUND: Follow-up for non-muscle invasive bladder cancer (NMIBC) is a challenge for urologists that has not been finally resolved. The intensity of follow-up is based on the recurrence and progression behavior of the tumor as well as the patient's individual situation. MATERIALS AND METHODS: The following article focuses on the current data situation, the valid German S3 guideline and the available instruments for the detection of relapses and progression, taking into account tumor stages and degree of malignancy. RESULTS: Urethrocystoscopy, imaging and urine cytology are generally recommended, but the recommendations appear to be too extensive in the case of so-called intermediate risk profiles. Depending on the situation, urine markers could optimize follow-up, although results from prospective randomized studies are still pending. CONCLUSIONS: The current follow-up of NMIBC is invasive, carries the risk of side effects and increases costs. In the absence of scientific evidence, recommendations for follow-up for NMIBC are naturally based on expert opinion. In the opinion of the authors, overdiagnosis is currently taking place particularly in patients with an intermediate risk profile. The first prospective, marker-based studies are ongoing and will be helpful in the near future to improve the data situation relevant to urological practice.