title: Can the burden of follow-up in low-grade noninvasive bladder cancer be reduced by photodynamic diagnosis, perioperative instillations, imaging, and urine markers?
abstract: OBJECTIVE
  Reduce the burden of follow-up for patients and healthcare providers in noninvasive bladder cancer (NIBC). The evolution of intraoperative tumor detection, imaging modalities, urinary markers, and intravesical instillation regimens as a possibility to improve tumor eradication, enhance noninvasive tumor monitoring and thus to reduce costs is reviewed.
  
  
  RESULTS
  On the basis of current evidence, the recurrence and progression of patients with NIBC can significantly be improved by fluorescence-guided transurethral resection and perioperative chemoinstillation. Virtual cystoscopic modalities based on computed tomography or magnetic resonance imaging as well as a combination of urine biomarkers, which improve the sensitivity of conventional urine cytology, has the potential to reduce discomfort and pain associated with conventional cystoscopy. Recent meta-analyses have furthermore demonstrated that risk-adapted instillation regimens for immediate, induction and maintenance therapy using immuno-instillation and chemoinstillation therapy improve significantly recurrence-free and progression-free survival rates.
  
  
  CONCLUSIONS
  Emerging technologies in the field of tumor visualization in combination with urinary markers and effective instillation regimens can significantly reduce the risk of recurrence and progression in the long-term whilst providing less patient discomfort and simplifying the follow-up in patients of NIBC.
authors.affiliation: Department of Urology, Eberhard-Karls University, Tuebingen, Germany.
authors.forename: Georgios
authors.initials: G
authors.lastname: Gakis
authors.forename: Stephan
authors.initials: S
authors.lastname: Kruck
authors.forename: Arnulf
authors.initials: A
authors.lastname: Stenzl
mesh_terms: D000283:Administration, Intravesical; D014408:Biomarkers, Tumor / Q000652:urine*; D017024:Chemotherapy, Adjuvant; D017046:Cost Savings; D003558:Cystoscopy; D003952:Diagnostic Imaging / Q000191:economics / Q000379:methods*; D018450:Disease Progression; D018572:Disease-Free Survival; D017048:Health Care Costs; D006801:Humans; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000191:economics / Q000517:prevention & control*; D009367:Neoplasm Staging; D017319:Photosensitizing Agents / Q000191:economics; D011237:Predictive Value of Tests; D013997:Time Factors; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis / Q000191:economics / Q000473:pathology / Q000601:surgery* / Q000652:urine; D013520:Urologic Surgical Procedures / Q000191:economics
chemical_list: D014408:Biomarkers, Tumor; D017319:Photosensitizing Agents