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Surveillance and Monitoring

  • Daniel J. Canter
  • Joseph Zabell
  • Stephen A. Boorjian
  • Christopher J. WeightEmail author
Chapter

Abstract

Disease recurrence has been reported in up to half of patients undergoing radical cystectomy for bladder cancer. Various regimens have been outlined for surveillance of patients following surgery, often with disparate recommendations regarding the intensity of follow-up and the choice of imaging. Moreover, debate exists as to whether routine oncologic follow-up in fact impacts patient survival. Currently, the best predictors for metastases remain pathologic tumor stage and lymph node status. Common sites of bladder cancer metastases include the thoracic cavity, peritoneum, liver, bone, and, less frequently, isolated to the pelvis. The majority of recurrences have been documented within the first 2–3 years after cystectomy. Patients do remain at long-term risk for metachronous tumors of the upper urinary tract, and may benefit from risk-stratified surveillance with imaging and cytology. Meanwhile, urethral recurrence after cystectomy is relatively infrequent. Conflicting evidence has been reported regarding the benefit of routine screening with urethral cytology, and as such guideline recommendations are inconsistent but do suggest a risk-adapted strategy, targeting patients with pathologic evidence of prostatic tumor involvement at surgery who have been found to have the highest risk for urethral recurrence. In addition, given the metabolic abnormalities that may occur following urinary diversion, including in particular renal function decline, continued functional surveillance in these patients is recommended to facilitate early detection and management of such complications.

Keywords

Disease recurrence Metastatic surveillance Upper tract recurrence Urethral recurrence Cytology Metabolic acidosis Vitamin B12 

Abbreviations

RC

Radical cystectomy

GFR

Glomerular filtration rate

BCS

Bladder cancer-specific survival

PFS

Progression-free survival

NCCN

National Comprehensive Cancer Network

ICUD

International Consultation on Urologic Diseases

EAU

European Association of Urology

UUT

Upper urinary tract

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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Daniel J. Canter
    • 1
  • Joseph Zabell
    • 2
  • Stephen A. Boorjian
    • 3
  • Christopher J. Weight
    • 2
    Email author
  1. 1.Urologic Institute of Southeastern PennsylvaniaEinstein Healthcare NetworkPhiladelphiaUSA
  2. 2.Department of UrologyUniversity of MinnesotaMinneapolisUSA
  3. 3.Mayo ClinicRochesterUSA

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