Herr HW et al. (2007) Management of low grade papillary bladder tumors. J Urol 178: 1201–1205

More than half of all patients diagnosed with bladder cancer have low-grade, noninvasive papillary tumors. Current treatment comprises initial transurethral resection (TUR), sometimes with immediate chemotherapy. Patients are then followed up intensively, since this type of bladder tumor recurs frequently; however, low-grade bladder tumors rarely progress in grade or become life threatening, so repeat surveillance every 3 months by cystoscopic examination and TUR under anesthesia might burden patients with years of frequent, uncomfortable, invasive and potentially unnecessary procedures.

Herr et al. propose that low-grade bladder cancer could be better managed using a strategy that increases the interval between cystoscopies and reduces, or even eliminates, ambulatory surgical procedures. They devised a follow-up regime involving flexible cystoscopy, a less invasive procedure, to check for recurrences every 6 months, combined with office-based fulguration (a nonsurgical treatment in which small tumors detectable by cystoscopy are destroyed using a microelectrode).

Their evaluation of 215 patients diagnosed with noninvasive papillary bladder tumors revealed that 143 patients had at least one tumor recurrence over 10 years. After a median follow-up of 8 years, there was an average of 6.2 recurrences per year, requiring 0.34 TUR per year. Only 17 patents experienced tumor progression and one patient died of bladder cancer. The authors conclude that surveillance cystoscopy every 6 months, coupled with outpatient fulguration, is sufficient to control recurrent tumors. This management strategy also reduces the therapeutic burden for patients.