Upper tract imaging surveillance is not effective in diagnosing upper tract recurrence in patients followed for nonmuscle invasive bladder cancer Journal Article


Authors: Sternberg, I. A.; Keren-Paz, G. E.; Chen, L. Y.; Herr, H. W.; Donat, S. M.; Bochner, B. H.; Dalbagni, G.
Article Title: Upper tract imaging surveillance is not effective in diagnosing upper tract recurrence in patients followed for nonmuscle invasive bladder cancer
Abstract: Purpose We evaluated the usefulness of routine upper tract imaging in patients followed for nonmuscle invasive bladder cancer. Materials and Methods A retrospective review of patients treated for nonmuscle invasive bladder cancer between 2000 and 2006 was conducted. Kaplan-Meier curves were calculated to determine upper tract urothelial carcinoma-free probability for stage Ta and T1 disease. Bladder cancer stage was included as a time dependent covariate. Descriptive statistics were used to report rates of imaging studies used and the efficacy in diagnosing upper tract urothelial carcinoma. Results Of 935 patients treated and followed for nonmuscle invasive bladder cancer 51 were diagnosed with upper tract urothelial carcinoma. Median followup was 5.5 years. The 5-year upper tract urothelial carcinoma-free probability among patients with Ta and T1 disease was 98% and 93%, respectively. The 10-year upper tract urothelial carcinoma-free probability among patients with Ta and T1 disease was 94% and 88%, respectively. Only 15 (29%) patients were diagnosed on routine imaging while the others were diagnosed after symptoms developed. Overall 3,074 routine imaging scans were conducted for an overall efficacy of 0.49%. Conclusions Upper tract recurrence is a lifelong risk in patients with bladder cancer, but most cases will be missed on routine upper tract imaging. The majority of upper tract urothelial carcinoma can be diagnosed using a combination of thorough history taking, physical examination, urine cytology and sonography, indicating that routine surveillance imaging may not be the most efficient way to detect upper tract recurrence. © 2013 by American Urological Association Education and Research, Inc.
Keywords: adult; cancer survival; aged; major clinical study; cancer recurrence; cancer staging; follow up; diagnostic imaging; urinary bladder neoplasms; survival time; watchful waiting; transitional cell carcinoma; non muscle invasive bladder cancer; carcinoma transitional cell
Journal Title: Journal of Urology
Volume: 190
Issue: 4
ISSN: 0022-5347
Publisher: Elsevier Science, Inc.  
Date Published: 2013-10-01
Start Page: 1187
End Page: 1191
Language: English
DOI: 10.1016/j.juro.2013.05.020
PROVIDER: scopus
PUBMED: 23680310
DOI/URL:
Notes: --- - Cited By (since 1996):1 - "Export Date: 1 October 2013" - "CODEN: JOURA" - "Source: Scopus"
Altmetric Score
MSK Authors
  1. Guido Dalbagni
    260 Dalbagni
  2. Sherri M Donat
    135 Donat
  3. Bernard Bochner
    332 Bochner
  4. Harry W Herr
    417 Herr
  5. Ling Yun Chen
    16 Chen