Is Regular Radiographic Upper Urinary Tract Imaging for Surveillance of Non-Muscle Invasive Bladder Cancer Justified?

SIMPLE SUMMARY: Patients with non-muscle invasive (NMI) urothelial bladder cancer (BC) are more likely to have a second cancer in the upper urinary tract (UTUC). During bladder cancer follow-up, UTUC can be detected early by regular imaging of the upper urinary tract. However, there is little evidence that this strategy is useful. We performed a retrospective analysis of patients with NMIBC treated at our center between 2003 and 2016. Our results show that regular imaging has a low detection rate and that UTUCs were only found in individuals who already had a high-risk disease, suggesting that only these individuals may require upper-tract surveillance. In the future, risk-adjusted follow-up strategies should be explored. ABSTRACT: Patients with non-muscle invasive (NMI) urothelial bladder cancer (BC) are at increased risk for the development of a secondary upper-urinary-tract urothelial carcinoma (UTUC). We aimed to assess the usefulness of routine upper-tract imaging surveillance during NMIBC follow-up in a patient cohort of a tertiary academic center. All routine upper-tract-imaging scans using computerized tomography urography (CTU) between 2003 and 2016 were assessed for UTUC detection. A total of 315 patients were analyzed. Initial tumor stage was Ta in 207 patients (65.7%), T1 in 98 patients (31.1%) and pure CIS in 10 patients (3.2%). A total of 149 (47.3%) presented with low-grade (LG), and 166 (52.7%) with high-grade (HG) disease. Median follow-up was 48 months (IQR: 55). Four patients (1.2%) were diagnosed with UTUC during follow-up. All four patients presented with initial Ta HG BC. Two of the patients (50%) were diagnosed by routine upper tract imaging. The other two patients were diagnosed after development of symptoms. The 5- and 10-year UTUC-free survival was 98.5% (standard error (SE) 0.9) and 97.6% (SE 1.3), respectively. UTUCs were detected exclusively in patients with initial HG disease, indicating that upper-tract surveillance might only be necessary in these patients.