Understanding risk and refining surveillance following tumor resection for low grade non-muscle invasive bladder cancer

Breaking clinical dogma can be difficult, particularly when the practice in question is easy and billable (i.e., routine office cystoscopy for surveillance of bladder cancer). von Landenberg and colleagues provide an organized, multiinstitutional study examining the conditional recurrence and progression-free survival (PFS) of TaG1 non-muscle invasive bladder cancer (NMIBC) to help clinicians better individualize patient care (1). Perhaps this data may help reduce dogmatic and unnecessary procedures and tests every three months for all NMIBC patients regardless of risk. Despite guideline recommendations and increasing focus on risk-aligned surveillance, implementation can be quite challenging in busy clinical practices (2-4). Given that more than 70% of all bladder cancers are NMIBC and many patients live a long time with their disease (i.e., median survival for patients with NMIBC is over 9 years) (5), the clinical utility of the authors’ conclusions is quite meaningful.