Cystectomy Follow-Up May Be Avoidable

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Follow-up examinations offer no survival benefit to patients who are asymptomatic following radical cystectomy for bladder cancer, according to a study published in The Journal of Urology (2009;181:1587-1593).

Bjoern G. Volkmer, MD, and colleagues at the University of Ulm in Ulm, Germany, analyzed outcomes from 1,270 radical cystectomies for bladder cancer. All patients had regular follow-up examinations with chest x-rays and abdominal ultrasonography every three months, abdominal CT scans every six months, and bone scans and excretory urography every 12 months.

After a mean 20 and 17.5 months following radical cystectomy, local tumor recurrence or distant metastasis was diagnosed in 290 symptomatic patients and 154 asymptomatic patients, respectively, the investigators reported.

The overall survival rate one, two, and five years after first recurrence was 18.9%, 8.2%, and 2.9% in symptomatic patients and 22.5%, 10.1%, and 5.5% in asymptomatic patients, respectively. The difference in survival rates between these patient groups was not significant. This study did not include upper urinary tract or urethral tumor recurrence.

The investigators said their study fails to show a survival benefit for detecting tumor recurrence early by regular follow-up examinations at an asymptomatic stage. They concluded that symptom-guided follow-up examinations may provide similar results at lower cost.

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