Radical cystectomy is the standard treatment for patients with nonmetastatic transitional cell carcinoma of the bladder. Despite bladder excision, disease recurs in approximately one-third of patients; thereafter, prognosis is poor. It is difficult to predict which patients will experience a recurrence. Gianluca Giannarini et al. investigated whether routine postoperative follow-up can effectively detect disease re-emergence, thereby enhancing survival.

A total of 479 patients underwent regular follow-up evaluations for a median of 4.3 years after radical cystectomy for transitional cell carcinoma. Tumor recurrence was detected in 174 study participants—by routine follow-up in 87 cases, and as a result of patient-reported symptoms in another 87. Recurrence was classed as pelvic, distant, concomitant pelvic and distant, or secondary urothelial; whichever was detected first.

...routine monitoring of patients after radical cystectomy can be beneficial, particularly for the detection of carcinoma in situ

Lung metastases and urethral recurrences were detected primarily by routine follow-up. The presence of bone metastases and associated pelvic or distant recurrences was indicated mainly by symptoms. Management (chemotherapy, external-beam radiotherapy, surgery, brachytherapy, bacillus Calmette–Guérin, or no active treatment) depended on the site and extent of recurrence, and on patient comorbidities.

Kaplan–Meier estimates of 5-year cancer-specific and overall survival were 69.8% and 61.9%, respectively, for all patients. Urethral recurrences occurred in 24 patients, 13 of whom had carcinoma in situ. Urethra-sparing therapy was used successfully in 12 of these patients.

The means of diagnosing disease re-emergence, as well as the site of initial recurrence, independently predicted both cancer-specific and overall survival. Patients whose asymptomatic recurrence was detected by follow-up investigations, and those in whom the urothelium was the site of initial recurrence, were more likely to survive than patients presenting with symptomatic recurrences (hazard ratios of 0.66 and 0.46, respectively).

The authors conclude that routine monitoring of patients after radical cystectomy can be beneficial, particularly for the detection of carcinoma in situ. They also note the utility of routine cross-sectional imaging of bladder cancer survivors, in light of the predominance of lung and extra-pelvic metastases in these patients.