ARTICLE Provider Treatment Intensity and Outcomes for Patients With Early-Stage

jnci.oxfordjournals.org JNCI | Articles 571 Bladder cancer is the fifth most common new cancer diagnosis and among the most expensive cancers to treat in the United States ( 1). Nearly three-quarters of incident cases of bladder cancer are non – muscle-invasive (ie, early-stage) tumors ( 2), which are removed endoscopically. In up to half of these patients, the disease will progress to muscle-invasive cancer ( 3 – 6). Because mortality from muscle-invasive disease is common ( 7, 8) and often requires a major medical intervention (radical cystectomy, systemic chemotherapy, and/or radiation therapy), effective strategies for the prevention and early detection of disease progression are of paramount importance. How best to achieve this goal remains unclear. Common strat-egies for bladder cancer surveillance and treatment that may be useful include intensive intravesical therapy, repeat endoscopic re-section after diagnosis, and frequent endoscopic surveillance ( 9, 10). However, evidence from randomized clinical trials establishing the optimal approaches to bladder cancer surveillance and treat-ment is largely lacking. Rather, current guidelines for the surveil-lance and treatment of early-stage bladder cancer are mos