There is no standardized regimen for follow-up after radical cystectomy (RC) for bladder cancer (BC). To address this gap, we conducted a multicenter study involving urologist members from the European Association of Urology (EAU) bladder cancer guideline panels. Our objective was to identify consistent post-RC follow-up strategies and develop a practice-based framework based on expert opinion.
We surveyed 27 urologist members of the EAU guideline panels for non-muscle-invasive bladder cancer and muscle-invasive and metastatic bladder cancer using a pre-tested questionnaire with dichotomous responses. The survey inquired about follow-up strategies after RC and the use of risk-adapted strategies. Consistency was defined as >75% affirmative responses for follow-up practices commencing 3 mo after RC. Descriptive statistics were used for analysis.
We received responses from 96% of the panel members, who provided data from 21 European hospitals. Risk-adapted follow-up is used in 53% of hospitals, with uniform criteria for high-risk (at least ≥pT3 or pN+) and low-risk ([y]pT0/a/1N0) cases. In the absence of agreement for risk-based follow up, a non-risk-adapted framework for follow-up was developed. Higher conformity was observed within the initial 3 yr, followed by a decline in subsequent follow-up. Follow-up was most frequent during the first year, including patient assessments, physical examinations, and laboratory tests. Computed tomography of the chest and abdomen/pelvis was the most common imaging modality, initially at least biannually, and then annually from years 2 to 5. There was a lack of consistency for continuing follow-up beyond 10 yr after RC.
This practice-based post-RC follow-up framework developed by EAU bladder cancer experts may serve as a valuable guide for urologists in the absence of prospective randomized studies.
We asked urologists from the EAU bladder cancer guideline panels about their patient follow-up after surgical removal of the bladder for bladder cancer. We found that although urologists have varying approaches, there are also common follow-up practices across the panel. We created a practical follow-up framework that could be useful for urologists in their day-to-day practice.
European urology oncology. 2024 Jun 20 [Epub ahead of print]
Laura S Mertens, Harman Maxim Bruins, Roberto Contieri, Marek Babjuk, Bhavan P Rai, Albert Carrión Puig, Jose Luis Dominguez Escrig, Paolo Gontero, Antoine G van der Heijden, Fredrik Liedberg, Alberto Martini, Alexandra Masson-Lecomte, Richard P Meijer, Hugh Mostafid, Yann Neuzillet, Benjamin Pradere, John Redlef, Bas W G van Rhijn, Matthieu Rouanne, Morgan Rouprêt, Sæbjørn Sæbjørnsen, Thomas Seisen, Shahrokh F Shariat, Francesco Soria, Viktor Soukup, George Thalmann, Evanguelos Xylinas, Paramananthan Mariappan, J Alfred Witjes
Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands. Electronic address: ., Department of Urology, Zuyderland Medical Center, Sittard-Heerlen, The Netherlands., Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands., Department of Urology, Teaching Hospital Motol, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic., Department of Urology, Freeman Hospital, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK., Department of Urology, Hospital Universitari Vall d'Hebron, Barcelona, Spain., Department of Urology, Instituto Valenciano de Oncologia, Valencia, Spain., Division of Urology, Department of Surgical Sciences, AOU Citta della Salute e della Scienca, Torina School of Medicine, Turin, Italy., Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands., Department of Urology, Skane University Hospital, Malmö, Sweden; Institute of Translational Medicine, Lund University, Malmö, Sweden., Department of Urology, MD Anderson Cancer Center, Houston, TX, USA., Department of Urology, Saint-Louis Hospital, AP-HP, Paris Cité University, Paris, France., Department of Oncological Urology, University Medical Center Utrecht, Utrecht, The Netherlands., Department of Urology, Royal Surrey Hospital, Guildford, UK., Department of Urology, Foch Hospital, University of Versailles-Saint-Quentin-en-Yvelines, Suresnes, France., Department of Urology, La Croix du Sud Hospital, Quint Fonsegrives, France., Patient Representative, European Association of Urology Guidelines Office, Arnhem, The Netherlands., Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany., GRC 5, Predictive Onco-Urology, Sorbonne University, Department of Urology, Pitié-Salpetriere Hospital, Paris, France., Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Division of Urology, Department of Special Surgery, University of Jordan, Amman, Jordan; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria; Department of Urology, Weill Cornell Medical College, New York, NY, USA; Department of Urology, University of Texas Southwestern, Dallas, TX, USA; Department of Urology, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic., Department of Urology, General Teaching Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic., Department of Urology, Inselspital, University Hospital Bern, Bern, Switzerland., Department of Urology, Bichat-Claude Bernard Hospital, AP-HP, Université Paris Cité, Paris, France., Edinburgh Bladder Cancer Surgery, University of Edinburgh, Western General Hospital, Edinburgh, UK.