Reviewed by Morgan Rouprêt, Professor at the AP-HP Sorbonne University in the Academic Urology Department of the Pitié-Salpêtrière Hospital, Paris, France.
Prof. Rouprêt is a panel member of the European Guidelines for non-muscle invasive bladder cancer (NMIBC).
The 2021 EAU guidelines on non-muscle invasive bladder cancer (NMIBC) allow to use urinary markers as method of surveillance in Ta low grade bladder cancer, in case cystoscopy is not possible or refused by the patient [1].
For years, the EAU guidelines recommend regular cystoscopy for the follow-up of NMIBC. However, the follow-up schedules with cystoscopy have weak recommendations as they are not evidence-based.
Urinary markers have the opportunity to aid the current follow-up procedures and to reduce the burden associated with regular cystoscopies. Bladder cancer biomarker tests with a high NPV, high sensitivity and high specificity can predict tumour absence with great accuracy and can easily be implemented in daily clinical practice.
The EAU 2020 guidelines already acknowledged a potential role for diagnostic urinary markers:
“A test able to predict absence of tumour will have great utility in daily clinical practice.”
Watch the editorial comment by Prof. Dr. Paolo Gontero on biomarker statements in the EAU 2020 guidelines.
In the new EAU 2021 guidelines, one important statement was added:
“In patients initially diagnosed with Ta G1-2/low grade (LG) bladder cancer, ultrasound of the bladder or a urinary marker may be a mode of surveillance in case cystoscopy is not possible or refused by the patient” [1]
This update acknowledges the possibility of introducing an alternative follow-up schedule for patients with TaG1-2/ LG NMIBC in 2 situations:
- When cystoscopy not possible – Due to the ongoing COVID-19 pandemic, cystoscopies may be cancelled/delayed due to adapted regulations.
- When cystoscopy is refused – Cystoscopy can cause discomfort and pain. A patient might prefer a non-invasive alternative over cystoscopy.
Patients should be properly informed on urinary markers for bladder cancer surveillance. This will help to optimise and individualise the follow-up schedule for each patient, so that both physicians and patients are satisfied.
References
- Babjuk M, Burger M, Compérat E, et al. EAU guidelines on non-muscle-invasive bladder cancer. Update April 2021. Available at: https://uroweb.org/guideline/non-muscle-invasive-bladder-cancer/