The International Bladder Cancer Group has issued consensus recommendations on the diagnosis and management of low-grade Ta (LGTa) bladder cancer.
Key recommendations include:
- Cystoscopic appearance on cystoscopy (i.e. papillary architecture, low-grade appearance) should determine subsequent management.
- Urinary cytology is not required at time of surveillance for LGTa tumours unless high-grade bladder cancer is suspected.
- Initial LGTa-appearing tumours can be removed with a cold cup biopsy forceps or resected by loop resection.
- Imaging of the upper urinary tract during surveillance (except for ultrasound) is not recommended.
- Enhanced cystoscopic techniques provide sufficient benefit to warrant their use at the time of diagnosis.
- Single, post-operative instillation of intravesical chemotherapy is recommended when feasible.
- There is no major role for maintenance intravesical therapy in the management of low-risk tumours.
- For recurrent tumours, avoid unnecessary intravesical chemotherapy or BCG therapy. However, intravesical therapy should be considered if the number, frequency, timing of recurrence or size of new tumours requires more frequent intervention.
- Surveillance flexible cystoscopy is recommended at 3 and 6-12 months after initial diagnosis, then every 6-12 months for 5 years as long as no new tumours develop.
- Cystoscopic surveillance may be discontinued after a 5-year disease-free interval.