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One of the treatment options for Low Grade (LG) Non-Muscle Invasive
Bladder Cancer (NMIBC) is represented by Active Surveillance (AS), suggested
for the first time in 2003 by Soloway and Coll, and actually recommended by
International Guidelines. AS allows a reduction of the number of Trans-Urethral
Resection of Bladder Tumour (TURBT) throughout the patients’ lifetime, without
compromising the possibility of intervention in case of progression. AS is
feasible considering the fact that a non-negligible number of pts are old and
often present considerable comorbidities, with subsequent increasing risks,
partly due to anesthesia and partly due to complications of TURBT per se,
especially in case of repeated procedures. Our group have published three
papers since 2016 up to 2018, about the results of patients included in a local
national observational program [Bladder Cancer Italian Active Surveillance -
(BIAS) project] after diagnosis of recurrence. The progression rate was 13.1%
and 7.4% about grade and stage, respectively. Moreover, we demonstrated that AS
can reduce the life-time cost of this category of pts by avoiding unnecessary
frequent surgeries without increasing the risk of progression. Before COVID-19
outbreak, over 200 patients were on AS and we usually performed 7 cystoscopies
per week in an outpatient setting. However, the pandemic has led to a reduction
of number of patients who can potentially meet the inclusion criteria of AS, as
well as the possibility to be admitted to hospital in order to perform
follow-up procedures. In this scenario, we could take advantage from SARS-Cov-2
thanks to two possible amendments of BIAS, strictly applicable during this
pandemic: 1. Increasing the maximum number of lesions (from 5 to 7) which leads
to TURBT; 2. Extension of follow-up period during AS from 3 to 6 months.
Finally, these amendments can lead to an increasing number of patients in AS.
Keywords: Bladder cancer, Active surveillance,
Cystoscopy, Pandemic, COVID-19
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