A SURVEILLANCE SCHEDULE FOR G1Ta BLADDER CANCER ALLOWING EFFICIENT USE OF CHECK CYSTOSCOPY AND SAFE DISCHARGE AT 5 YEARS BASED ON A 25-YEAR PROSPECTIVE DATABASE

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Abstract
In the absence of clear evidence, surveillance of low grade superficial bladder cancer by regular check cystoscopy may continue unnecessarily, or discharge from followup may occur empirically. We review the followup during a prospective 25-year period of patients presenting with G1Ta bladder cancer, and it is this analysis on which we base a safe schedule for discharge. A prospectively kept, computerized record of bladder cancers diagnosed between 1978 and 1985 and subsequently followed up at the Western General Hospital, Edinburgh was reviewed. A total of 115 patients with G1Ta disease were followed for a mean of 19.4 years. Tumor status at 3 months was the strongest prognostic factor for recurrence. Although the absence of tumor at 1 year was also a favorable prognostic sign, it was not for 5 years that the situation entirely stabilized (recurrence developed in 8 of 66 such patients between 1 and 5 years). Of those who did not have recurrence in 5 years, 98.3% patients remained tumor-free for 20 years. In contrast in those with recurrence at 3 months the recurrence rate was much higher. Overall 12% of patients experienced progression, mostly in year 1. None of the 8 who had their first recurrence after year 1 had disease progression. Patients with G1Ta disease who are free of recurrence for 5 years after presentation can be safely discharged. We propose to alter the regime for patients with no recurrence in year 1 and discharge them at 5 years.