Henry, 70 years old, used to work as a creative director in a chocolate factory. Once, he designed chocolates that looked like broccoli. Too bad, they were not favoured by the clients …
He was initially diagnosed with a solitary small Ta low-grade (LG) tumour. He received 1 immediate chemotherapy instillation after transurethral resection of the bladder tumour (TURBT).
Follow-up cystoscopy after 6 months shows a 1 cm papillary tumour and TURBT is performed. Visual appearance suggests a low grade and he received again 1 immediate chemotherapy instillation. The pathology report confirms urothelial cancer pTa LG (muscle in specimen, no LVI).
He received mitomycin C instillations for 1 year. In the meantime, no recurrences were detected during follow-up.
His follow-up visit at 12 months post-TURBT:
- Cystoscopy: negative
- Cytology: negative
The patient indicated he finds multiple cystoscopies burdensome.
Question 1: Which option for surveillance would you propose to this patient (assuming all of the below options are available and fully covered for the patient)?
Cystoscopy 6 months later
Urinary biomarker 6 months later*
Cystoscopy 12 months later
* if negative, cystoscopy another 6 months later; if positive, cystoscopy immediately
Question 2: In case the patient refused to continue with cystoscopic follow-up altogether, which option for surveillance would you propose to this patient (assuming all of the below options are available and fully covered for the patient)?
Offer surveillance with urinary biomarker
Try to convince the patient to continue with cystoscopic surveillance
No further NMIBC surveillance**
** perform cystoscopy only following symptoms, such as haematuria
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