Active surveillance of low grade bladder tumors.

OBJECTIVE: This study was done in order to evaluate the safety of an active surveillance program, without resection of the tumor, in patients with recurrent small bladder cancer. PATIENTS AND METHODS: Active surveillance was offered to patients with small (<10 mm) papillary, asymptomatic tumor(s) with negative urinary cytology that was found on routine follow-up in patients who had previous resection(s) of superficial (Ta) low-grade (G1-2) bladder tumor(s). The surveillance protocol included cystoscopy and urinary cytology every 3 months for 2 years and then every 6 months. Surveillance was stopped and the patient referred to transurethral tumor resection if the patient had developed either symptoms related to the tumor, or positive cytology, or if there has been a significant alteration in tumor morphology, size or upon patient's request. RESULTS: 43 active surveillance periods were documented in 31 patients (mean age 68 years). Mean period length was 16.1 months (S.D. 15.7 months and range 3-60 months). 35 surveillance periods were terminated with tumor resection and 8 patients are still under surveillance. The main reasons for termination of surveillance were the appearance of additional tumors (15 events), excessive tumor growth (12 events) and patient's request (7 events). All resected tumors were stage Ta except a single case of stage T1. CONCLUSIONS: Recurrent papillary bladder tumors in patients with history of low grade Ta tumor(s) pose minimal risk for the patient. An active surveillance policy, without immediate resection of the tumor may be considered in these cases.