Active surveillance for non-muscle-invasive bladder cancer: fallacy or opportunity?
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Active surveillance for non-muscle-invasive bladder cancer: fallacy or opportunity? / von Deimling, Markus; Pallauf, Maximilian; Bianchi, Alberto; Laukhtina, Ekaterina; Karakiewicz, Pierre I; Rink, Michael; Shariat, Shahrokh F; Pradere, Benjamin.
in: CURR OPIN UROL, Jahrgang 32, Nr. 5, 01.09.2022, S. 567-574.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Review › Forschung
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TY - JOUR
T1 - Active surveillance for non-muscle-invasive bladder cancer: fallacy or opportunity?
AU - von Deimling, Markus
AU - Pallauf, Maximilian
AU - Bianchi, Alberto
AU - Laukhtina, Ekaterina
AU - Karakiewicz, Pierre I
AU - Rink, Michael
AU - Shariat, Shahrokh F
AU - Pradere, Benjamin
N1 - Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2022/9/1
Y1 - 2022/9/1
N2 - PURPOSE OF REVIEW: This review aims to analyze the current place of active surveillance (AS) in non-muscle-invasive bladder cancer (NMIBC).RECENT FINDINGS: A growing body of evidence suggests that AS protocols for pTa low-grade (TaLG) NMIBC are safe and feasible. However, current guidelines have not implemented AS due to a lack of high-quality data. Available studies included pTa tumors, with only one study excluding pT1-NMIBC. Inclusion/exclusion criteria were heterogeneously defined based on tumor volume, number of tumors, carcinoma in situ (CIS), or high-grade (HG) NMIBC. Tumor volume <10 mm and <5 lesions were used as cut-offs. Positive urinary cytology (UC) or cancer-related symptoms precluded inclusion. Surveillance within the first year consisted of quarterly cystoscopy. AS stopped upon the presence of cancer-related symptoms, change in tumor morphology, positive UC, or patient's request. With a median time on AS of 16 months, two-thirds of the patients failed AS. Progression to muscle-invasive bladder cancer (MIBC) was rare and occurred only in patients with pT1-NIMBC at inclusion.SUMMARY: AS in NMIBC is an attractive concept in the era of personalized medicine, but strong evidence is still awaited. A more precise definition of patient inclusion, follow-up, and failure criteria is required to improve its implementation in daily clinical practice.
AB - PURPOSE OF REVIEW: This review aims to analyze the current place of active surveillance (AS) in non-muscle-invasive bladder cancer (NMIBC).RECENT FINDINGS: A growing body of evidence suggests that AS protocols for pTa low-grade (TaLG) NMIBC are safe and feasible. However, current guidelines have not implemented AS due to a lack of high-quality data. Available studies included pTa tumors, with only one study excluding pT1-NMIBC. Inclusion/exclusion criteria were heterogeneously defined based on tumor volume, number of tumors, carcinoma in situ (CIS), or high-grade (HG) NMIBC. Tumor volume <10 mm and <5 lesions were used as cut-offs. Positive urinary cytology (UC) or cancer-related symptoms precluded inclusion. Surveillance within the first year consisted of quarterly cystoscopy. AS stopped upon the presence of cancer-related symptoms, change in tumor morphology, positive UC, or patient's request. With a median time on AS of 16 months, two-thirds of the patients failed AS. Progression to muscle-invasive bladder cancer (MIBC) was rare and occurred only in patients with pT1-NIMBC at inclusion.SUMMARY: AS in NMIBC is an attractive concept in the era of personalized medicine, but strong evidence is still awaited. A more precise definition of patient inclusion, follow-up, and failure criteria is required to improve its implementation in daily clinical practice.
KW - Carcinoma in Situ/epidemiology
KW - Cystoscopy
KW - Humans
KW - Neoplasm Invasiveness
KW - Urinary Bladder Neoplasms/diagnosis
KW - Watchful Waiting
U2 - 10.1097/MOU.0000000000001028
DO - 10.1097/MOU.0000000000001028
M3 - SCORING: Review article
C2 - 35869738
VL - 32
SP - 567
EP - 574
JO - CURR OPIN UROL
JF - CURR OPIN UROL
SN - 0963-0643
IS - 5
ER -