Introduction

Surveillance cystoscopy in patients with non-muscle invasive bladder cancer is associated with pain, anxiety, and often necessitates antibiotic prophylaxis. Novel imaging and blood/urine based non-invasive alternatives are being developed to detect bladder cancer recurrence/progression in this patient population. We conducted a questionnaire-based hypothetical study to determine what test performance characteristics and cost would a non-invasive test(s) need in order for patients and their physicians to avoid cystoscopy.

Methods

A questionnaire was administered to two populations (patients with previous history of non-muscle invasive bladder cancer and uro-oncologists) to establish an acceptable false negative (FN) rate and cost for such test(s). Patients were surveyed at time of follow up in the cystoscopy clinic at Toronto General Hospital. Physician members of the Society of Urologic Oncology were surveyed via an online questionnaire. Participants were questioned regarding demographics and other characteristics that might influence chosen error rate and cost. A chi-square test was used to determine if such relationships exist. Statistical significance was set at p <0.05.

Results

137 patient and 51 physician responses were obtained. 102 (75%) of the patients were male and 35 (25%) were female. 77% of patients were not comfortable with a non-invasive test(s) in place of repeat cystoscopy, with a further 14% requesting a false-negative (FN) rate of 0.5% or better. 75% of uro-oncologists were comfortable with an alternative non-invasive test, with 31% of responders requesting a FN rate of 5% or better and 33% a FN rate of 1% or better. A cost of $100-500 was deemed appropriate by 61% of physician responders. Demographics and other participant characteristics did not influence FN rate or cost choices.

Conclusions

Majority of bladder cancer patients are not comfortable with a non-invasive test(s) in place of surveillance cystoscopy, as opposed to most uro-oncologists who are. Given the importance of patient input in clinical decision-making, it appears that non-invasive tests will not replace surveillance cystoscopies in the near future, unless they achieve equivalent accuracy.

Funding

None