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<p>Standard management for recurrent low-grade non-muscle-invasive bladder cancer (LG-NMIBC) often involves a substantial treatment burden, which is not justified by the relatively indolent course of the disease, prompting a need for de-intensification strategies. Active surveillance (AS) is an alternative approach aimed at reducing overtreatment in selected patients. However, the broader adoption of AS is hindered by a lack of standardized protocols for patient selection, monitoring and intervention. To address this gap, we conducted an international, two-round Delphi consensus among 51 bladder cancer experts to establish foundational statements for the use of AS. Consensus was achieved on 20 statements, providing clear recommendations for terminology; inclusion and exclusion criteria; follow-up monitoring; and exit criteria. This Delphi consensus provides the first expert-driven framework to standardize the clinical application of AS for LG-NMIBC. These statements could guide current clinical practice and unify the design of future trials.</p>

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Active surveillance in low-grade NMIBC — results of an international two-round modified Delphi consensus

  • 期刊论文

  • 发表日期：

    2026年4月1日

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  • Roberto Contieri,
  • Paolo Gontero,
  • Rodolfo Hurle,
  • Luca Afferi,
  • Simone Albisinni,
  • Marek Babjuk,
  • Alison Birtle,
  • Peter Black,
  • Maurizio Brausi,
  • Max Bruins,
  • Otakar Čapoun,
  • Albert Carrion,
  • James Catto,
  • Ananya Choudhury,
  • Alessia Cimadamore,
  • Eva Comperat,
  • Siamak Daneshmand,
  • David D’andrea,
  • Francesco Del Giudice,
  • Jose Luis Domínguez Escrig,
  • Patrick Hensley,
  • Wojciech Krajewski,
  • Ekaterina Laukhtina,
  • Roger Li,
  • Fredrik Liedberg,
  • Yair Lotan,
  • Gautier Marcq,
  • Paramananthan Mariappan,
  • Andrea Mari,
  • Alberto Martini,
  • Alexandra Masson Lecomte,
  • Richard Meijer,
  • Maria Carmen Mir,
  • Keiichiro Mori,
  • Marco Moschini,
  • Hugh Mostafid,
  • Micheal O’Donnell,
  • Joan Palou,
  • Valeria Panebianco,
  • Sisto Perdonà,
  • Sima Porten,
  • Sarah Psutka,
  • Michael Rink,
  • Morgan Roupret,
  • Thomas Seisen,
  • Mark Soloway,
  • Viktor Soukup,
  • Gary Steinberg,
  • Arnulf Stenzl,
  • Jeremy YC Teoh,
  • Karl Tully,
  • Toine van der Heijden,
  • Bas W. G. van Rhijn,
  • Alfred Witjes,
  • Evanguelos Xylinas,
  • Ashish M. Kamat,
  • Benjamin Pradere,
  • Laura S. Mertens

摘要

Standard management for recurrent low-grade non-muscle-invasive bladder cancer (LG-NMIBC) often involves a substantial treatment burden, which is not justified by the relatively indolent course of the disease, prompting a need for de-intensification strategies. Active surveillance (AS) is an alternative approach aimed at reducing overtreatment in selected patients. However, the broader adoption of AS is hindered by a lack of standardized protocols for patient selection, monitoring and intervention. To address this gap, we conducted an international, two-round Delphi consensus among 51 bladder cancer experts to establish foundational statements for the use of AS. Consensus was achieved on 20 statements, providing clear recommendations for terminology; inclusion and exclusion criteria; follow-up monitoring; and exit criteria. This Delphi consensus provides the first expert-driven framework to standardize the clinical application of AS for LG-NMIBC. These statements could guide current clinical practice and unify the design of future trials.