Patient opinion of urinary tests versus flexible urethrocystoscopy in follow-up examination for superficial bladder cancer: a utility analysis

Abstract

Objectives. Urethrocystoscopy (UCS) is the reference standard diagnostic test in the follow-up of patients with superficial bladder cancer. The major disadvantage of this method is its invasive character. Urine cytology is not bothersome for the patient and does not cause any morbidity. However, it is not sensitive enough to replace UCS. Extensive research is being done to develop a urinary test with high sensitivity to serve as an attractive noninvasive alternative to UCS. In this study we examined patients’ opinions about the required validity of noninvasive diagnostic tools. Methods. One hundred two patients who were at least 1 year in follow-up for superficial bladder cancer were given a questionnaire, and 85 of them were interviewed by telephone. Questions were asked about their experience with flexible UCS, the number of UCS procedures they had undergone, and the number of recurrences. With the use of the standard gamble method, a utility analysis was performed to obtain the individual minimal accepted sensitivity (MAS) for a urinary test at which the patient would prefer that test to UCS. Results. Eleven percent of the patients required an MAS of 60% to 85%, 21% an MAS of 90% to 95%, and 68% an MAS of 99% to 100%. A higher MAS was found in women, younger people (67 years old or younger), patients who had undergone UCS more frequently, and patients with recurrences. Conclusions. If the sensitivity of a urinary test is lower than 90%, 89% of the patients will prefer flexible UCS as the diagnostic method in the follow-up of superficial bladder cancer.