Consider the same patient, but now with the following changes (marked in yellow):
Henry, a 70-year-old former creative director in a chocolate company, was initially diagnosed with a solitary small Ta low-grade (LG) tumour. He received 1 immediate chemotherapy instillation during transurethral resection of the bladder tumour (TURBT).
Follow-up cystoscopy after 12 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 CIS).
He received mitomycin C instillations for 1 year. In the meantime, no recurrences were detected during follow-up.
His follow-up visit at 15 months post-TURBT:
- Cystoscopy: negative
The patient indicated he finds multiple cystoscopies burdensome and refuses to continue with cystoscopic follow-up.
Cast your vote and see what Prof. Morgan Rouprêt recommends for this what-if scenario!
Surveillance break until symptoms appear
Urinary cytology only
Urinary biomarker only
Ultrasound only
Ultrasound + urinary cytology
Ultrasound + urinary biomarker
Convince the patient to continue with cystoscopy, optionally alternating with urinary biomarker