Patients with non-muscle invasive bladder cancer (NMIBC) have high recurrence and progression rates in spite of tumor resection and adjuvant instillation therapy. To detect recurrences and progression, these patients remain under frequent follow-up. Follow-up, however, is not well defined. Frequency and duration of follow recommendations are based on low levels of evidence, which is illustrated by clear differences in these recommendations per guideline, even when specified per risk group. Additionally, follow-up is recommended with cystoscopy and cytology in selected patients, which both have clear limitations. Fact is that follow-up in NMIBC is too frequent, with low levels of evidence and suboptimal tools, and it is patient unfriendly and costly. Improved cystoscopy techniques are unproven or impractical in the outpatient follow-up setting. Urinary markers have been around for decades, but never widely used in clinical practice. New (epi)genetic markers, however, could play a significant role in future follow-up of NMIBC. They have been shown to have very high negative predictive values for recurrences in follow-up of NMIBC, especially high-grade recurrences. Several studies suggested that these markers could be used to adapt follow-up cystoscopy frequency. What still needs study and confirmation is the cost-effectiveness of the use of these markers, which is highly dependent on health care costs per country and marker price. In all, however, implementation of these new urinary markers after confirmation of current results might significantly reduce patient burden and health care costs in the near future without reducing quality.
World journal of urology. 2020 Dec 26 [Epub ahead of print]
J Alfred Witjes
Department of Urology, University Medical Center Nijmegen, Radboudumc (610), P. O. Box 9101, 6500 HB, Nijmegen, The Netherlands. .
PubMed http://www.ncbi.nlm.nih.gov/pubmed/33367941
"follow" - Google News
December 30, 2020 at 03:00PM
https://ift.tt/3n07z8u
Follow-up in non-muscle invasive bladder cancer: facts and future. - UroToday
"follow" - Google News
https://ift.tt/35pbZ1k
https://ift.tt/35rGyU8
Bagikan Berita Ini
0 Response to "Follow-up in non-muscle invasive bladder cancer: facts and future. - UroToday"
Post a Comment