<p><strong> </strong><strong>For intermediate-risk patients whose first surveillance cystoscopy is negative for tumor, clinicians should perform subsequent cystoscopy with cytology every 3-6 months for 2 years, then 6-12 months for years 3 and 4, and then annually thereafter. (<em>Expert Opinion</em>)</strong></p>
Discussion
Discussion
<p>Unlike the case for low-risk patients, there are no prospective studies that compare outcomes among differing cystoscopic surveillance regimens for intermediate-risk NMIBC patients. However, the risk of progression among these patients is higher, and in the absence of data to demonstrate otherwise, the Panel felt a slightly more intensive cystoscopic surveillance regimen was warranted. Panel consensus and historic precedence support surveillance cystoscopy and urinary cytology every three to six months for two years, then every six to twelve months for years three and four, and then annually thereafter. The Panel felt that the gaps in the literature should permit clinicians more flexibility and clinical judgment in determining the surveillance cystoscopic regimen in the intermediate-risk group compared to the high-risk group (see below). Future research is needed to determine if less stringent follow-up regimens can be employed without significantly affecting oncologic outcomes in both intermediate- and higher-risk patients, especially as the time to recurrence increases beyond five years. As with low-risk tumors, shared decision-making is imperative beyond five years if the patient remains disease-free.</p>