Oncologic Follow-Up After Radical Cystectomy: Is There Any Benefit?

Main Category: Urology / Nephrology
Article Date: 27 Jun 2008 - 6:00 PDT

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ORLANDO, FL (UroToday.com) - Tumor recurrence following radical cystectomy (RC) for bladder cancer can be detected in an asymptomatic patient by regular follow-up or in a symptomatic patient by symptom-guided examinations. The standard follow-up after RC is with a chest X-ray and routine blood work every 6 months, and CT-scan of the abdomen and pelvis yearly. Additional examinations were required for symptomatic disease. The authors evaluated whether a more intensive follow-up regimen to detect asymptomatic tumor recurrence offers better survival rates.

The authors evaluated 1,270 patients who underwent a RC between 01/86 and 12/06 at a single institution. All patients had regular follow-up examinations with chest X-ray and abdominal ultrasound every 3 months, CT-scan of the abdomen every 6 months, bone scan and IVU every 12 months. The authors analyzed first site and date of tumor recurrence, but recurrences of the upper urinary tract and of the urethra were excluded from this analysis. Survival was compared using the log-rank test.

The 20-year recurrence rate was 48.6% in the complete series. 444 patients developed tumor recurrence. In 154 cases it was detected in an asymptomatic stage by follow-up examinations (mean time after RC was 20 months), in 290 cases it was detected by symptom-guided examinations (mean time after RC was 17.5 months). The most frequent symptoms were: pain (51%), ileus (7%), acute urinary retention (4%), hydronephrosis with flank pain (5%), hematuria (5%), neurologic symptoms (4%), and palpable mass (4%). 41% of patients had local recurrences and 73% had distant failure at the time of first recurrence. The overall survival at 1, 2, and 5 years following diagnosis of first recurrence was: asymptomatic patients: 22.5%, 10.1%, and 5.5% respectively; symptomatic patients: 18.9%, 8.2%, and 2.9% respectively (log-rank: n.s.).

The authors concluded that there was no survival benefit for detecting tumor recurrence early at an asymptomatic stage by regular follow-up examinations. These data show, that symptom-guided follow-up examinations may offer similar results at lower costs. However, evaluation of upper-tract tumors is necessary.

Presented by Bjoern G Volkmer, MD, Georg C Bartsch, MD, Rainer Kuefer, MD, Richard E Hautmann, MD, at the Annual Meeting of the American Urological Association (AUA) - May 17 - 22, 2008. Orange County Convention Center - Orlando, Florida, USA.

Reported by UroToday.com Contributing Editor David P. Wood, MD

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