For patients with non-muscle invasive bladder cancer, active surveillance seems reasonable and cost-effective, according to a study published in the February issue of The Journal of Urology.
Rodolfo Hurle, M.D., from Humanitas Research Hospital in Rozzano, Italy, and colleagues conducted a prospective observational study involving patients with a history of pathologically confirmed stage pTa or pT1a non-muscle invasive bladder cancer as well as recurrent small size and number of tumours without haematuria and positive urine cytology.
There were 146 active surveillance events in 122 patients out of a total of 625 patients with non-muscle invasive bladder cancer. The researchers found that 40.4 percent of the events were deemed to require treatment after the patient entered active surveillance. Patients were on active surveillance for a median of 11 months; 62.3 percent of patients remain under observation. Only time from the first transurethral resection to the start of active surveillance was inversely associated with recurrence-free survival on univariable analysis (hazard ratio, 0.99). There was an association with age at initiation of active surveillance (hazard ratio, 0.97) and the size of the lesion at the first transurethral resection (hazard ratio, 1.55), in multivariable analysis. For each transurethral tumour resection avoided, the average specific annual resource consumption savings was considerable.
“Active surveillance might be a reasonable clinical and cost-effective strategy in patients who present with small, low grade pTa/pT1a recurrent papillary bladder tumours,” the authors wrote.
REFERENCE: Hurle et al: Active Surveillance for Low Risk Nonmuscle Invasive Bladder Cancer: A Confirmatory and Resource Consumption Study from the BIAS Project; http://www.jurology.com/article/S0022-5347(17)77391-0/fulltext