The Impact Of Re-Tur On Clinical Outcomes In A Large Cohort Of T1g3 Patients Treated With Bcg.

INTRODUCTION AND OBJECTIVES: Low risk non-muscle invasive bladder cancer (NMIBC) is an heterogeneous neoplasm, characterized by a high percentage of recurrences but a low tendency of progression. In this group of patients, overtreatment posts and impact in the quality of life and it implies high significant economical costs and an important deterioration of the quality of life, without evidence of improving their survival. Therefore, it seems reasonable to develop a program based on surveillance and monitoring of new recurrences. Our aim is to report our experience with low-risk bladder cancer patients under an active surveillance program after cancer recurrence, and to analyse which variables might help to predict progression. METHODS: From 2006 we have offered the option of active surveillance to all low risk tumours at time of recurrence. Follow-up included flexible cystoscopy and cytology every six months. TUR was performed when tumour size or number of lesions increased, at high grade cytology, when hematuria, tumour aspect worsened or patients’ choice. RESULTS: 68 patients were included. Mean age at recurrence was 71.5 years. Only 13,2% were female. Almost all patients received immediate postoperative mytomicin C (96%). Histological initial features were stage pTa in 48.5%, stage pT1a in 25%, pTx in 7.4% and PUNLMP in 17.6%; all were low grade. Mean time between TUR and recurrence was 33 months. The mean follow-up was 25,8 months. 32 (47%) patients underwent TUR after recurrence (mean time 20 months). Main cause of TUR (50%) was the increase of the number of lesions and tumor size, 18% due to hematuria, 6% to positive citology. Concerning recurrence features, 80% were single tumors and size was 5 mm in 60%. Seven patients (21.87%) progressed in stage (pTa to pT1a) (4) or grade (3). All patients with progression, tumor size was 5 mm or had positive cytology. None of our patients progressed to muscle invasive bladder cancer. CONCLUSIONS: Patients with recurrent, small, non muscleinvasive bladder tumours can be safely offered monitoring under an active surveillance protocol. Active surveillance can be safely considered in patients with less than 5mm recurrence or negative cytology.