Catto - Figure 34
Risk varies with time
FIG. 34: As with high-risk patients (Figure 31) data from the EORTC show that most time-to-recurrence and time-to-progression events occur in the first few years after initial diagnosis,[21] and therefore physicians should try to adjust cystoscopic surveillance and attention to these times.
I do not believe that cystoscopy through a rigid scope is necessary for most of these patients. We are not looking for occult carcinoma in situ for most of them; most of the time we are looking for significant worsening of disease, which looks different but is rare, or local symptomatic recurrence that requires resection. As a result I believe flexible cystoscopy is usually sufficient for most of these patients. Most events have occurred by 5 years, and so long-term follow-up is probably unjustified; I suggest that most patients should be followed up for 5 years and then get re-referred when they experience a change or recurrence of their symptoms.
References
Holmäng S, Hedelin H, Anderström C, et al. Recurrence and progression in low grade papillary urothelial tumors. J Urol. 1999;162:702−7
