<p><strong> </strong><strong>For high-risk patients whose first surveillance cystoscopy is negative for tumor, clinicians should perform subsequent cystoscopy with cytology every three to four months for two years, then six months for years three and four, and then annually thereafter. (<em>Expert Opinion</em>)</strong></p>
Discussion
Discussion
<p>As with intermediate-risk patients, there are no prospective studies that compare outcomes among differing cystoscopic surveillance regimens for high-risk NMIBC patients. Given the risk of progression among high-risk patients is higher than any other group, the Panel felt a more intensive cystoscopic surveillance regimen was warranted. Panel consensus and historic precedence support surveillance cystoscopy and urinary cytology every three months for two years, then every six months for years three and four, and then annually thereafter. As with intermediate-risk disease, there is an urgent need for studies to determine if less stringent follow-up regimens can be employed without significantly affecting oncologic outcomes in these patients. As the risk of recurrence decreases and the time to recurrence increases beyond five years, a decision to decrease the frequency of cystoscopy or stop routine follow-up cystoscopy after five years should only be made after a shared decision-making conversation with the patient.</p>