Oncological Followup After Radical Cystectomy For Bladder Cancer-Is There Any Benefit?

Main Category: Urology / Nephrology
Also Included In: Cancer / Oncology
Article Date: 14 Apr 2009 - 0:00 PDT

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UroToday.com - The rationale for routine radiographic, blood, and urine studies after a cancer therapy in asymptomatic patients is to identify metastases early and administer effective therapy and thus improve survival compared to patients who are symptomatic.

In this article, Dr. Bjoern Volkmer and colleagues evaluated 1,270 patients who underwent a radical cystectomy for bladder cancer. Routine radiographic, blood, and urine studies were done every 6 to 12 months. 49% of the patients had recurrent disease with 20 years of follow-up. Of the 444 patients with recurrent disease, 154 were asymptomatic and 290 had symptoms, most commonly pain, ileus, urinary retention, flank pain, hematuria, and a palpable mass. 41% had a local recurrence and 73% had distant metastases. The overall survival rate 1, 2 and 5 years after first recurrence was 22.5%, 10.1% and 5.5% in asymptomatic patients, and 18.9%, 8.2% and 2.9% in symptomatic patients, respectively (log rank not significant). Therefore, no survival advantage was found in asymptomatic compared to symptomatic patients.

If routine follow-up was important you would have expected the survival to be better in the asymptomatic patients. This suggests that early treatment of metastatic bladder cancer does not lead to improved survival. Symptom-guided follow-up examinations may provide similar survival rates at a lower cost.

Volkmer BG, Kuefer R, Bartsch GC Jr, Gust K, Hautmann RE
J Urol. 2009 Apr;181(4):1587-93
10.1016/j.juro.2008.11.112
Written by UroToday.com Contributing Editor David P. Wood, MD

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