{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T08:04:15Z","timestamp":1784966655209,"version":"3.55.0"},"reference-count":21,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2023,3,25]],"date-time":"2023-03-25T00:00:00Z","timestamp":1679702400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Medicine"],"published-print":{"date-parts":[[2023,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>To assess urinary symptoms and urine cytology as screening tools for cystoscopic detection of local recurrence after bladder\u2010preserving trimodality treatment (TMT).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients with muscle\u2010invasive bladder cancer receiving definitive TMT follow\u2010up three monthly for 2\u2009years, six monthly for the next 3\u2009years and then yearly, with a clinical review, urine cytology and cystoscopy at each visit (triple assessment, TA). Grade 2+ cystitis\/haematuria absent\/present was scored 0\/1, and urine cytology reported negative\/suspicious or positive was scored 0\/1, respectively. The performance of these two parameters for predicting local recurrence in cystoscopic biopsy was tested. Other hypothetical surveillance schedules included cystoscopy on alternate visits (COAV), or suspected recurrence (COSR), six\u2010monthly COSR and six\u2010monthly TA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 630 follow\u2010up visits in 112 patients with 19 recurrences (7 muscle invasive, 12 non\u2010muscle invasive) at a median follow\u2010up of 19\u2009months were analysed. The sensitivity and specificity of clinical symptoms were 47.4% and 92%, and for urine cytology 58% and 85%, respectively. The combination of clinical symptoms and cytology (COSR) was 95% sensitive and 78% specific for local recurrence but 100% sensitive for muscle\u2010invasive recurrence. Both COAV and COSV schedules showed a high area under the curve (AUC) for detecting local recurrence (COAV\u00a0=\u00a00.84, COSR\u00a0=\u00a00.83), muscle\u2010invasive recurrence (AUC\u00a0=\u00a00.848 each) and non\u2010muscle\u2010invasive recurrence (COAV\u00a0=\u00a00.82, COSR\u00a0=\u00a00.81); reducing the need for TAs by 64% and 67% respectively, and overall cost by 18% and 33%, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Cystoscopy at suspected recurrence during follow\u2010up is safe and the most cost\u2010effective for detecting muscle\u2010invasive local recurrences, while cystoscopy at alternate visits may be more optimal for detecting any local recurrence.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cam4.5840","type":"journal-article","created":{"date-parts":[[2023,3,25]],"date-time":"2023-03-25T19:49:52Z","timestamp":1679773792000},"page":"11305-11314","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Utilising alternative cystoscopic schedules to minimise cost and patient burden after trimodality therapy for muscle\u2010invasive bladder cancer"],"prefix":"10.1002","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4511-7782","authenticated-orcid":false,"given":"Rahul","family":"Krishnatry","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology Tata Memorial Centre and Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Homi Bhabha National Institute (HBNI)  Mumbai 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