Interdisciplinary Swiss consensus recommendations for follow-up after radical cystectomy and trimodal treatment for muscle-invasive bladder cancer

Abstract

Introduction

Radical cystectomy or trimodal therapy are treatment options for non-metastatic bladder cancer. However, there is limited evidence guiding post-treatment follow-up regimens, resulting in variations in care.

Objective

A Swiss consensus meeting aimed to identify gaps in follow-up strategies and subsequently tailoring follow-up protocols after curative treatment for bladder cancer.

Methods

A consensus meeting including participants from urology, oncology, radiation oncology, neuro-urology, international advisors, and patient representatives was held. 19 pre-formulated questions addressing follow-up duration, frequency, and modalities after radical cystectomy or trimodal therapy for bladder cancer were discussed and voted by participants.

Results

42 experts from 22 institutions participated in the meeting. Agreement was reached on several important elements of oncological and functional follow-up like risk-adapted follow-up and regular usage of patient reported outcome measures (PROMs) and 3 novel personalized follow-up schedules were suggested, balancing oncological surveillance, and monitoring functional complications.

Conclusion

We agreed on 3 newly developed Swiss follow up schedules for patients with bladder cancer who underwent cystectomy or trimodal therapy with curative intent; these protocols include stage-specific recommendations for type and timing of investigations to detect relapse combined with balanced measures to monitor functional complications such as PROMS and specific clinical examinations. These protocols will be evaluated in a prospective national multicentric cohort study.

Keywords

bladder cancer radical cystectomy trimodal therapy follow up relapse PROMS

Introduction

Bladder cancer represents a significant public health challenge, with approximately 500,000 new cases and 200,000 deaths reported annually worldwide.¹ Radical cystectomy is commonly performed for localized muscle-invasive bladder cancer but carries significant morbidity, impacting negatively on patients’ quality of life.^2,3 Trimodal therapy, i.e., radical/complete transurethral resection of bladder tumor (TURBT) followed by chemo-radiotherapy, offers an alternative approach for selected patients.⁴ In Switzerland, approximately 700 cystectomies and 50–70 trimodal therapies are performed annually.⁵ Five-year survival rates for both treatments are around 50%, with half of the patients experiencing relapses during follow-up.^6,7 Additionally, a significant number of patients is estimated to suffer from functional complications after treatment, contributing to significant healthcare costs.⁸ The economic burden of this follow-up care is substantial, for example cross-sectional imaging alone costing approximately CHF 1 million annually (with average costs of around 600 CHF for a computed tomography (CT) of the abdomen/pelvis/chest, and 2 CT scans in the first year of follow up for the annually treated patients alone), in addition to expenses for other follow-up investigations.

Despite the critical role of follow-up care to detect relapses and monitor for functional complications, there is a lack of standardized protocols guiding surveillance after cystectomy and trimodal therapy.⁹ We held a Swiss consensus meeting to develop follow-up strategies that balance the risks of over- and under-monitoring and to agree on follow-up protocols in preparation of a national prospective bladder cancer follow-up trial to generate robust evidence in order to finally improve patient outcomes.

Methods

A national consensus meeting was held on May 17, 2024, in Lucerne, Switzerland. The meeting, organized by Swiss Group for Clinical Cancer Research (SAKK), invited 60 bladder cancer experts from 26 Swiss healthcare institutions, representing various specialties involved in the management of bladder cancer such as urology, neuro-urology, oncology, and radiation oncology. Of these, 42 experts from 22 institutions (20 (48%) urology, 2 (4%) neuro-urology, 10 (24%) oncology, 10 (24%) radiation oncology) participated in the meeting. 2 International advisors and 3 patient representatives also joined the meeting.

Participants were selected by inviting all chief physicians from Swiss institutions treating patients with muscle-invasive bladder cancer. The physicians were invited to participate personally or to nominate a senior physician (e.g., consultant, senior attending) with substantial expertise in this field. This ensured representation from all major institutions and comprehensive clinical experience in uro-oncology across Switzerland.

Our three systematic reviews^6,7,10 along with 19 pre-formulated questions regarding follow-up duration, frequency, and modalities, were circulated among the participants for pre-conference voting 1 month before the event. The meeting included group discussions in workshop format, with participants rotating between four groups to ensure a variety of perspectives on different topics related to oncological and functional follow-up after radical cystectomy and trimodal therapy. Quantitative summaries of the discussions were presented, followed by a live second round of voting on the 19 questions.

Voting results before and after the consensus meeting were compared using Fisher's exact test. The qualitative group discussions were summarized descriptively to provide context for the voting outcomes but were not subjected to formal statistical or qualitative analysis.

Results

Follow-up after radical cystectomy

All participants agreed on the importance of both functional and oncological follow-up after surgery. The first three months post-cystectomy are critical, particularly for patients with a continent diversion. A minimum of three follow-up visits (3, 6, and 12 months) was recommended for the first year, followed by 6–12 monthly visits. Opinions were split between lifelong follow-up (41%) and personalized follow-up based on recurrence risk (41%) (Table 1). Our group agreed on two follow-up protocols: a minimum schedule for low-risk patients (defined as <(y)pT2pN0) and a regular schedule for higher risk disease (defined as >(y)pT2pN0), aligned with current European Association of Urology (EAU) guidelines for oncological interventions (Table 2). This approach matches the Expert Practices developed by EAU Bladder Cancer Guideline Panels which was published shortly after our consensus conference.¹¹

Table 1.

Responses to consensus questions before and after the conference.

Question	Answer Option	Response before conference (n = 31)	Response after conference (n = 29)	p-value (Fishers exact Test)
Oncological
Given the different risks of recurrence, in your opinion how many different follow-up protocols should be defined for oncological follow-up after cystectomy?	1 protocol: current guideline recommendation	7% (2)	3% (1)	1.00
	2 protocols: example ≤(y)pT2, >(y)pT2	42% (13)	66% (19)	0.077
	3 protocols: example: ≤(y)pT1pN0, (y)pT2pN0 and >(y)pT2pN0	51% (16)	31% (9)	0.12
	4 protocols	-	-	-
	>4 protocols	-	-	-
	Abstain	-	-	-
Considering the FDA-approved ctDNA test (Signatera^®) which is prognostic for disease recurrence post-radical cystectomy, would you use it in your practice if it were reimbursed in Switzerland?	Not at all	-	3% (1)	0.48
	Only within a research project but without changing the follow-up protocol	74% (23)	90% (26)	0.30
	This data is already compelling enough for me to reduce the number of cross-sectional imaging	7% (2)	7% (2)	1.00
	Abstain	19% (6)	-	0.024
For post-cystectomy follow-up, which imaging modalities should be utilized?	CT only	68% (21)	76% (22)	0.78
	MRI	7% (2)	3% (1)	1.00
	FDG-PET-CT	3% (1)	-	1.00
	Combination of 2 or 3 of those imaging modalities	13% (4)	14% (4)	1.00
	Abstain	9% (3)	7% (2)	1.00
Is Urethroscopy indicated during follow-up after a neobladder?	Yes at every visit	-	7% (2)	0.24
	Yes but only in patients with risk factors	35% (11)	41% (12)	0.80
	In symptomatic patients only	26% (8)	24% (7)	1.00
	Not at all	3% (1)	-	1.00
	Abstain	35% (11)	28% (8)	0.59
Is Urethroscopy indicated during follow-up after urinary diversion without neobladder?	Yes at every visit	-	3% (1)	0.48
	Yes but only in patients with risk factors	35% (11)	45% (13)	0.60
	In symptomatic patients only	26% (8)	17% (5)	0.54
	Not at all	3% (1)	3% (1)	1.00
	Abstain	352% (11)	31% (9)	0.79
Should forced diuresis cytology to monitor upper tract urinary cancers be performed during follow up?	Yes	55% (17)	41% (12)	0.32
	No	7% (2)	24% (7)	0.076
	Abstain	39% (12)	35% (10)	0.79
When should oncological follow-up be stopped?	After 5 years	23% (7)	21% (6)	1.00
	After 10 years	13% (4)	21% (6)	0.50
	Follow-up should be lifelong	9% (3)	10% (3)	1.00
	Follow-up should be personalized according to risk of recurrence and survival	51% (16)	48% (14)	1.00
	Abstain	3% (1)	-	1.00
Should patients be screened for germ line mutations?	Yes, all patients should be screened	3% (1)	-	1.00
	Only if immunohistochemistry (IHC) is suggesting Lynch syndrome	7% (2)	7% (2)	1.00
	Only if family history is suspicious	9% (3)	14% (4)	0.71
	Only if immunohistochemistry (IHC) is suggesting Lynch syndrome or a suspicious family history	61% (19)	62% (18)	1.00
	Never	-	-	-
	Abstain	19% (6)	17% (5)	1.00
Assuming stage depending risks of recurrence after trimodal therapy, in your opinion how many different follow-up protocols should be defined for oncological follow-up after trimodal therapy?	1 protocol (current guideline recommendation)	19% (6)	21% (6)	1.00
	2 protocols (example ≤ cT2cN0, >cT2cN0)	39% (12)	52% (15)	0.44
	3 protocols (example ≤ cT2, >cT2, cN1)	23% (7)	21% (6)	1.00
	Further subgroups stratified e.g., by response to chemo-radiation, absence of hydronephrosis, complete TURBT	19% (6)	6% (2)	0.26
	4 protocols	-	-	-
	>4 protocols	-	-	-
	Abstain	-	-	-
For post-trimodal therapy follow-up, which imaging modalities should be utilized?	CT only	51% (16)	62% (18)	0.45
	MRI	7% (2)	3% (1)	1.00
	FDG-PET-CT	-	-	-
	Combination of 2 or 3 of those imaging modalities	32% (10)	31% (9)	1.00
	Abstain	9% (3)	3% (1)	0.61
How many Urethroscopies do you recommend in the first 24 months follow-up after trimodal therapy?	8, every 3 months	35% (11)	52% (15)	0.30
	4, every 6 months, but 3 monthly cytology and visits	19% (6)	6% (2)	0.26
	4, every 6 months	13% (4)	21% (6)	0.50
	Only in patients with either hematuria, symptoms or suspicious urine cytology	-	3% (1)	0.48
	Abstain	32% (10)	17% (5)	0.24
How many urinary cytologies do you recommend in the first 24 months follow-up after trimodal therapy?	8, every 3 months	55% (17)	28% (8)	0.040
	4, every 6 months	29% (9)	31% (9)	1.00
	In symptomatic patients only	-	3% (1)	0.48
	Not at all	-	24% (7)	0.004
	Abstain	16% (5)	14% (4)	1.00
Do you recommend random bladder biopsies during follow-up after trimodal therapy?	Yes at every visit	3% (1)	-	1.00
	Yes but only once after 3-6 months	26% (8)	6% (2)	0.08
	Yes but only in patients with risk factors	9% (3)	10% (3)	1.00
	In symptomatic patients only	9% (3)	3% (1)	0.61
	Only in patients with reddish areas	19% (6)	21% (6)	1.00
	Only in patients with papillary appearing lesions	19% (6)	41% (12)	0.091
	Abstain	13% (4)	17% (5)	1.00
The FDA Bladder CARE^TM urinary test is prognostic for disease recurrence after TURBT, would you use it after trimodal therapy if it were reimbursed in Switzerland?	Not at all	3% (1)	6% (2)	1.00
	Only within a research project but without changing the follow-up protocol	84% (26)	90% (26)	0.71
	This data is compelling enough for me to reduce the number of flexible cystoscopies after trimodal therapy	-	3% (1)	0.48
	Abstain	13% (4)	-	0.48
Functional
When should functional follow-up be stopped?	After 5 years	7% (2)	14% (4)	0.42
	After 10 years	23% (7)	-	0.011
	Follow-up should be lifelong	35% (11)	41% (12)	0.80
	Follow-up should be personalized according to risk of recurrence and survival	29% (9)	41% (12)	0.43
	Abstain	7% (2)	3% (1)	1.00
Should bicarbonate be supplemented to achieve a blood level of 23 to 26 mmol/L?	Yes, in all patients to reach levels of 23 to 26 mmol/L	35% (11)	59% (17)	0.13
	Only in chronic kidney disease patients	39% (12)	31% (9)	0.79
	Only in symptomatic patients	26% (8)	10% (3)	0.11

Numbers in brackets indicate the number of votes for the answer option, if there are no answers for an option, a “-“ is given.

Table 2.

Risk-adapted follow up schedule after radical cystectomy.

Patient-reported outcome measures (PROMs) were unanimously endorsed, with several validated questionnaires selected to balance comprehensive assessment with practical implementation (see supplementary file). With these, general quality of life, bladder-cancer-specific complications including questions about pad usage, and a bladder diary/frequency volume chart, bowel symptoms, anxiety/depression and sexual function should be assessed. Additional brief questions to assess smoking habits and hematuria were included. This set of PROMs requires <15 min to complete and can be filled out remotely or in the waiting area before consultation.

All participants agreed, that neobladder patients require intensive monitoring during the initial three months post-cystectomy, with particular focus on voiding function. Management after catheter removal includes strict voiding intervals and periodically performed venous blood gas analyses (vBGA) to optimize bicarbonate supplementation, especially in patients with chronic kidney disease. Surveillance for lung cancer, hypertension, and diabetes, complications of neo-/adjuvant systemic therapies as well as a geriatric assessment in patients >70 years should remain within the scope of primary care physicians rather than being incorporated into specialist follow-up (Figure 1).

Figure 1.

Responses on questions regarding functional assessments/complications before and after the conference.

Laboratory monitoring is essential for post-cystectomy follow-up, encompassing metabolic parameters, vitamin B12 levels and screening for anemia. The panel showed majority support (59%) for universal bicarbonate supplementation (target: 23–26 mmol/L across all diversion types), while 31% favored selective use in chronic kidney disease. Regular renal function monitoring via creatinine measurements and ultrasound was emphasized, particularly for patients receiving adjuvant systemic therapy. Post-cystectomy patients also face an elevated risk of bone fractures, supporting the use of the Fracture Risk Assessment Tool (FRAX-score) including a bone mass density measurement at baseline, after 3 months and two years post-surgery.¹²

Physical examination should include assessment for prolapse and hernias (incisional and stomal). The panel endorsed genetic screening (62%) for patients with suspicious family histories or Lynch syndrome. Cross-sectional imaging received unanimous support, for which computed tomography (CT) were preferred (76%). While routine urine cytology for upper tract surveillance was only recommended by a minority of 41%, novel blood-based biomarkers (e.g., circulating tumor DNA, ctDNA) received strong support (90%) within research protocols without impacting treatment decisions yet. Urethroscopy with urethral wash cytology (performed during urethroscopy or with a Robinson catheter placed in the mid penile urethra) was recommended by 45% in patients with risk factors, including positive urethral margin, multifocal CIS or prostatic urethral invasion, while 31% abstained and 17% voted for this investigation only in symptomatic patients.

Follow-up after trimodal therapy

Functional follow-up received unanimous endorsement, with urinary, sexual, and bowel symptom monitoring prioritized given the bladder-preserving nature of treatment. The panel identified the need for trimodal therapy-specific PROMs and recommended validation through well-designed (cross-sectional, longitudinal) psychometric studies. Unlike post-cystectomy care, the panel advocated for symptom-driven laboratory testing rather than routine examinations.

The necessity of oncological follow-up after trimodal therapy was unanimously agreed upon, particularly due to the high risk of recurrence within the first 2 years, although a relevant proportion of patients may still experience relapse within 5 years after treatment. Because there was no consensus on a precise definition of oncological risk of recurrence, we suggested one single follow-up schedule after trimodal therapy (Table 3). All participants (100%) agreed on the use of cross-sectional imaging after trimodal therapy (Table 1) with 7 CT scans of the abdomen/pelvis/chest over the course of 5 years (Table 3), based on the current EAU guidelines for cystectomy patients. Regular urine cytology (bladder wash during cystoscopy) was recommended by 59% of participants, with 24% suggesting avoiding it due to limited accuracy. Random bladder biopsies were recommended by 41% of participants for patients with suspicious lesions. 90% of participants agreed to use novel urine-based biomarkers such as Bladder CARE™ within a prospective cohort study.

Table 3.

Follow up schedule after trimodal treatment.

	Months
Follow-up investigation	3	6	9	12	15	18	21	24	30	36	48 & 60	>year 5
History
-medication	X			X				X		X
-smoking, hematuria,	X			X				X		X
-PROMs (QoL, bladder-, stool-, sexual function, depression/anxiety)) and pads	X			X				X		X
-Bladder diary/Frequency volume chart	X			X				X		X
-Family history/Germ line analyses	X
Laboratory
-serum creatinine				X				X		X	X	Lifelong creatinine
-serum ctDNA¹	X	X		X		X		X		X	X
-urine Bladder CARE¹	X	X	X	X	X	X	X	X	X	X	X
Investigations
-CT chest/abdomen/pelvis		X		X		X		X	X	X	X	Yearly ultrasound and cystoscopies lifelong
-MRI pelvis using VIRADS¹	X	X	X	X		X		X	X	X	X
-urethro/-cystoscopy and cytology	X	X	X	X	X	X	X	X	X	X	every 6m
Counselling/Advice on:
-Sexual	X			X				X		X
-Urinary	X			X				X		X
-Kidney function	X			X				X		X
-Cardiovascular health	X			X				X		X

only in prospective clinical trial.

Patient perspective

The patient perspective about oncological and functional follow-up after radical cystectomy and trimodal therapy was consistently considered throughout the discussions. The patient representatives generally favored more frequent and less invasive follow-up methods, appreciating the reassurance provided by regular checks. However, they also expressed concerns about the potential anxiety associated with more invasive procedures and frequent hospital visits. Involvement of specialized nurses for functional complications and consistent healthcare providers was emphasized to enhance communication and reduce patient anxiety.

Discussion

Determining the optimal follow up protocol is crucial because excessive follow up may result in unnecessary health care expenditures and patient stress while infrequent follow up may miss opportunities for cancer control through salvage treatments. Currently, there is a lack of prospective evidence demonstrating a survival or quality-of-life benefit from intensive surveillance strategies compared to symptom-triggered investigations.¹³ This results in follow-up recommendations being largely based on expert opinion rather than evidence. With this meeting, we aimed to address this gap and lay the groundwork for future prospective trials that will enable evidence generation.

Our study presents the first Swiss consensus on follow-up protocols after radical cystectomy and trimodal therapy for muscle-invasive bladder cancer and could become a new standard of care. The high probability of recurrence and functional complications during follow-up leads to numerous visits, creating substantial burden for patients and healthcare systems. Our proposed follow-up protocols demonstrate the potential for meaningful personalization that balances early detection of recurrence and complications with resource utilization and burden for the patients.

We established a standardized set of PROMs to be assessed regularly during follow-up care. This implementation was driven by evidence that integrating PROMs into cancer care have the potential to improve overall survival, health-related quality of life, and reduce emergency consultations.^14,15 These selected measures help clinicians to systematically screen for complications and potential signs of recurrence, including functional complications and symptoms such as hematuria. We also incorporated the screening of smoking habits, as smoking is a significant risk factor for recurrence, enabling clinicians to provide targeted cessation support.¹⁶

Our consensus defined key investigations for detecting both functional complications and recurrence. Kidney function deterioration, observed in 6–29% of patients, requires particular attention.¹⁰ Uretero-intestinal strictures, occurring in 3–17% of patients and potentially developing up to 15 years post-surgery, necessitate regular monitoring through cross-sectional imaging, renal ultrasound, and serum creatinine measurements.¹⁷ Patients with urinary diversion require special attention to metabolic acidosis, with regular bicarbonate monitoring recommended for continent diversions.¹⁸ Vitamin B12 deficiency, affecting a significant proportion of patients, can present after urinary diversion due to malabsorption, supporting the need for regular hemoglobin and vitamin B12 measurements.¹⁰

Current literature suggests that approximately one-third of cystectomy patients could receive fewer CT scans, as those with ≤(y)pT2pN0 have a lower recurrence risk and could be adequately monitored with three rather than seven CT scans over the course of 5 years.^19,20 This modification alone could yield significant cost savings, estimated at approximately CHF 1–2 million over five years in Switzerland.

Emerging biomarkers present promising opportunities for enhancing follow-up care. Circulating tumor DNA (ctDNA) shows potential not only for disease staging and monitoring tumor burden but also for detecting relapse, potentially identifying recurrence 3–6 months earlier than radiographic findings.^6,21 In the trimodal therapy setting, ctDNA is also being evaluated in ongoing prospective trials (NCT05630131). Additionally, urinary methylation markers like Bladder CARE™ show promise for bladder cancer detection and surveillance. If validated, these biomarkers could reduce the need for invasive cystoscopies and frequent CT scans while potentially enabling earlier recurrence detection.²²

Regular counselling after cancer treatment is a crucial component of our recommendations. For sexual health, evidence supports providing education for patients and their partners after genitourinary cancer treatment.²³ Similar to post-prostatectomy care, options in men include early penile rehabilitation or a stepwise approach combining vacuum erection devices, phosphodiesterase type 5 inhibitors, or penile prosthesis implantation.²⁴ For female patients, interventions may include lubricants, topical vaginal estrogen, dilators, vibrators, pelvic floor rehabilitation, or referral to sex therapy.²⁵ Urinary function management requires comprehensive assessment through bladder diaries and standardized questionnaires, addressing incontinence, voiding function, pad usage, self-catheterization needs, and mucus production. Patients need clear guidance on voiding intervals and volumes, or instruction in self-catheterization for neobladder or pouch maintenance.²⁶ During follow-up, patients (especially with urinary diversions) should have access to specialized nursing support in the event of any of the above-mentioned issues or complications.

Cardiovascular health management remains essential, given its established impact on quality of life and survival in cancer survivors. Regular counselling on cardiovascular risk factors aligns with international guidelines.²⁷ This is particularly crucial as conditions like hypertension and diabetes contribute to renal insufficiency, which can complicate future platinum-based chemotherapy if needed for recurrence.²⁸

The strength of our consensus lies in its collaborative, multidisciplinary approach to establishing standardized follow-up recommendations. While we achieved agreement on personalized protocols balancing oncological surveillance with functional follow-up, we acknowledge these recommendations require validation through prospective studies.

Our recommendations were developed through a broad multidisciplinary collaboration involving urology, oncology, radiation oncology, neuro-urology, and patient representatives, but we acknowledge that certain professional groups essential to comprehensive survivorship care, such as nursing, geriatric medicine, psychosocial oncology, and rehabilitation were not represented in the panel. Including these perspectives could have further strengthened the recommendations, especially regarding quality of life, mental health, caregiver support, and social reintegration. Future efforts should aim to incorporate these groups more systematically, particularly as survivorship care becomes an increasingly central aspect of bladder cancer management.

While the Swiss healthcare system ensures universal access to medically necessary treatments through mandatory insurance and benefits from a high density of hospitals and specialists, we acknowledge that structural barriers, such as limited access to specialists, regional disparities, or variations in insurance coverage may pose significant challenges to implementing follow-up protocols in other countries. These factors must be considered when adapting our recommendations to different healthcare systems to ensure equitable access to follow-up care.

The upcoming centralization of cystectomies in Switzerland, supported by the Highly Specialized Medicine (HSM) mandate and national registry requirement, creates an ideal opportunity to address care gaps through prospective research. With 19 of 23 cystectomy centers already participating in the national registry, implementing a dedicated bladder cancer follow-up study appears feasible. Similar centralization efforts should be aimed for trimodal treatment. This approach mirrors our successful experience with testicular cancer, where consensus-driven protocols led to enhanced follow-up care through the Swiss Austrian German Testicular Cancer Cohort Study, which has successfully enrolled over 1000 patients with a rare cancer.²⁹

Conclusion

This consensus meeting suggests standardized follow-up recommendations for Swiss bladder cancer patients after radical cystectomy or trimodal therapy. Through multidisciplinary collaboration, we developed personalized follow-up schedules that balance the needs for oncological surveillance with functional monitoring. These protocols aim to optimize resource utilization while maintaining high-quality care.

The proposed schedules represent a significant step toward standardizing care across Swiss institutions. By incorporating both established diagnostic tools and emerging biomarkers, while accounting for patient-reported outcomes, these protocols offer a comprehensive approach to post-treatment monitoring. Implementation of these recommendations, followed by validation through prospective studies, has the potential to improve patient outcomes while ensuring efficient use of healthcare resources.

The momentum created by Switzerland's centralization of cystectomy care, combined with the existing national registry infrastructure, provides an ideal framework for evaluating these protocols through prospective research. This initiative represents a crucial step toward evidence-based, standardized follow-up care in bladder cancer patients.

Supplemental Material

sj-docx-1-blc-10.1177_23523735251410823 - Supplemental material for Interdisciplinary Swiss consensus recommendations for follow-up after radical cystectomy and trimodal treatment for muscle-invasive bladder cancer

Supplemental material, sj-docx-1-blc-10.1177_23523735251410823 for Interdisciplinary Swiss consensus recommendations for follow-up after radical cystectomy and trimodal treatment for muscle-invasive bladder cancer by Ernest Kaufmann, Stefanie Aeppli, Andres Affentranger, Nicolas Arnold, Winfried Arnold, Fabian Aschwanden, Panagiotis Balermpas, Jörg Beyer, Uwe Bieri, Joost Boormanns, Richard Cathomas, Berardino De Bari, Marco Dressler, Daniel S Engeler, Andreas Erdmann, Andrea Gallina, Silvia Gomez, Matthias Guckenberger, Thomas Herrmann, Thomas Hermanns, Ilaria Lucca, Hubert John, Thomas Matthias Kessler, Jan Klein, Mohamed Laouiti, David Lauffer, Seth Paul Lerner, Agostino Mattei, Michael Müntener, Daniel Nguyen, Philipp Niederberger, Alexandros Papachristofilou, Lukas Prause, Paul Martin Putora, Karsten Reinhardt, Emanuela Salati, Philippe Sèbe, Mohamed Shelan, Silvan Sigg, Räto Thomas Strebel, Arnoud Jan Templeton, Ursula Vogl, Marian Severin Wettstein, Stephen Wyler, Deborah Zihler, Thomas Zilli, Daniel Zwahlen, Beat Roth and Christian Daniel Fankhauser in Bladder Cancer

Footnotes

Acknowledgements

The authors would like to thank the Swiss Group of Clinical Cancer Research (SAKK) in Bern for their great administrative support in organizing the meeting and Gabriela Scherer from University of Lucerne for her professional moderation of the meeting.

ORCID iDs

Ernest Kaufmann

Andres Affentranger

Nicolas Arnold

Panagiotis Balermpas

Uwe Bieri

Thomas Matthias Kessler

Thomas Zilli

Christian Daniel Fankhauser

Authors’ contribution

C. Fankhauser, E. Kaufmann conceptualized and designed the study. C. Fankhauser, E. Kaufmann, A. Affentranger, F. Aschwanden, S. Sigg designed the methodology. All authors contributed to the acquisition of the data. Statistical analysis was performed by E. Kaufmann. C. Fankhauser, E.Kaufmann, A. Affentranger, F. Aschwanden, S. Sigg performed data curation. Formal analysis was performed by E. Kaufmann, C. Fankhauser. E. Kaufmann visualized the data. All authors interpreted the data and provided a critical assessment of the data. E. Kaufmann, C. Fankhauser were writing the original draft. All authors reviewed, edited and approved the final manuscript. C. Fankhauser supervised the project.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The consensus meeting was supported financially by Janssen, Pangea, Unilabs, Natera (Gold Sponsors), Krebsforschung Schweiz (AND-6010-01-2024-KFS, KFS-6065-02-2024), MSD (Silver Sponsors) and by Astellas and Gilead with an unrestricted scientific grant contribution. Neither of the companies was involved in defining the questions the panel voted on, and had no role in interpreting the results, or writing the manuscript.

Declaration of conflicting interests

The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Seth P. Lerner is an Editorial Board Member (Editor In-Chief) of this journal but was not involved in the peer-review process nor had access to any information regarding its peer-review.

Data availability

The data supporting the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

Supplemental material

Supplemental material for this article is available online.

References

Lenis

Lec

Chamie

, et al. Bladder cancer: a review. Jama 2020; 324: 1980–1991.

Catto

JWF

Downing

Mason

, et al. Quality of life after bladder cancer: a cross-sectional survey of patient-reported outcomes. Eur Urol 2021; 79: 621–632.

Mak

Smith

Eidelman

, et al. Quality of life in long-term survivors of muscle-invasive bladder cancer. Int J Radiat Oncol Biol Phys 2016; 96: 1028–1036.

James

Hussain

Hall

, et al. Radiotherapy with or without chemotherapy in muscle-invasive bladder cancer. N Engl J Med 2012; 366: 1477–1488.

Bundesamt für Gesundheit (BAG) - Qualitätsindikatoren Fallzahl radikale Zystektomien 2021/2021 . https://www.bag.admin.ch/bag/de/home/zahlen-und-statistiken/zahlen-fakten-zu-spitaelern/qualitaetsindikatoren-der-schweizer-akutspitaeler/qualitaetsindikatoren-fallzahl.exturl.html/, accessed 2025/02/02, 12:31pm.

Kaufmann

Black

Catto

, et al. Oncological surveillance after radical cystectomy, a narrative review of the enhanced recovery after surgery (ERAS) cystectomy committee. JU Open Plus 2023; 1: e00051.

Kaufmann

Aeppli

Arnold

, et al. Follow-up strategies after trimodal treatment for muscle-invasive bladder cancer: a systematic review. World J Urol 2024; 42: 27.

Madersbacher

Schmidt

Eberle

, et al. Long-term outcome of ileal conduit diversion. J Urol 2003; 169: 985–990.

Witjes

Bruins

Cathomas

, et al. European association of urology guidelines on muscle-invasive and metastatic bladder cancer: summary of the 2020 guidelines. Eur Urol 2021; 79: 82–104.

10.

Kaufmann

Black

Catto

, et al. Functional follow-up after cystectomy and urinary diversion: a narrative review. JU Open Plus 2023; 1: e00071.

11.

Mertens

Bruins

Contieri

, et al. Consistencies in follow-up after radical cystectomy for bladder cancer: a framework based on expert practices collaboratively developed by the European association of urology bladder cancer guideline panels. Eur Urol Oncol 2024; 8: 105–110.

12.

James

Aleksic

Bienz

, et al. Comparison of fracture risk assessment tool score to bone mineral density for estimating fracture risk in patients with advanced prostate cancer on androgen deprivation therapy. Urology 2014; 84: 164–168.

13.

Witjes

Babjuk

Bellmunt

, et al. EAU-ESMO Consensus statements on the management of advanced and variant bladder cancer-an international collaborative multistakeholder effort(†): under the auspices of the EAU-ESMO guidelines committees. Eur Urol 2020; 77: 223–250.

14.

Balitsky

Rayner

Britto

, et al. Patient-Reported outcome measures in cancer care: an updated systematic review and meta-analysis. JAMA Netw Open 2024; 7: e2424793.

15.

Basch

Deal

Kris

, et al. Symptom monitoring with patient-reported outcomes during routine cancer treatment: a randomized controlled trial. Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology 2016; 34: 557–565.

16.

Cacciamani

Ghodoussipour

Mari

, et al. Association between smoking exposure, neoadjuvant chemotherapy response and survival outcomes following radical cystectomy: systematic review and meta-analysis. J Urol 2020; 204: 649–660.

17.

Mahmoud

Krafft

Al-Nader

, et al. Risk factors for ureteroenteric stricture after radical cystectomy and urinary diversion: a systematic review. Arab J Urol 2024; 22: 61–69.

18.

Stein

Rubenwolf

. Metabolic consequences after urinary diversion. Front Pediatr 2014; 2: 15.

19.

Mak

Hunt

Shipley

, et al. Long-term outcomes in patients with muscle-invasive bladder cancer after selective bladder-preserving combined-modality therapy: a pooled analysis of radiation therapy oncology group protocols 8802, 8903, 9506, 9706, 9906, and 0233. Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology 2014; 32: 3801–3809.

20.

Wettstein

Antonelli

Martini

, et al. Stage-specific recurrence rates post-radical cystectomy: a path to personalized oncological follow-up. Eur Urol 2024; 85: S1366–S13S7.

21.

Lindskrog

Birkenkamp-Demtröder

Nordentoft

, et al. Circulating tumor DNA analysis in advanced urothelial carcinoma: insights from biological analysis and extended clinical follow-up. Clin Cancer Res 2023; 29: 4797–4807.

22.

Piatti

Chew

Suwoto

, et al. Clinical evaluation of bladder CARE, a new epigenetic test for bladder cancer detection in urine samples. Clin Epigenetics 2021; 13: 84.

23.

Schubach

Niyonsenga

Turner

, et al. Experiences of sexual well-being interventions in males affected by genitourinary cancers and their partners: an integrative systematic review. Support Care Cancer 2023; 31: 265.

24.

Sari Motlagh

Abufaraj

Yang

, et al. Penile rehabilitation strategy after nerve sparing radical prostatectomy: a systematic review and network meta-analysis of randomized trials. J Urol 2021; 205: 1018–1030.

25.

Avulova

Wittmann

. Optimizing women's sexual function and sexual experience after radical cystectomy. Urology 2021; 151: 138–144.

26.

Ghodoussipour

Ladi Seyedian

Jiang

, et al. Predictors of need for catheterisation and urinary retention after radical cystectomy and orthotopic neobladder in male patients. BJU Int 2021; 128: 304–310.

27.

Siobhan

Stuart

Duncan

, et al. Cardiovascular health: an important component of cancer survivorship. BMJ Oncology 2023; 2: e000090.

28.

Vejlgaard

Maibom

Stroomberg

, et al. Long-Term renal function following radical cystectomy for bladder cancer. Urology 2022; 160: 147–153.

29.

Rothermundt

Thurneysen

Cathomas

, et al. Baseline characteristics and patterns of care in testicular cancer patients: first data from the Swiss Austrian German testicular cancer cohort study (SAG TCCS). Swiss Med Wkly 2018; 148: w14640.

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