Urinary Biomarker–Guided Surveillance vs Standard Cystoscopy in NMIBC

A systematic review and meta-analysis evaluated urinary biomarker-guided surveillance versus standard cystoscopy-based surveillance in adult patients with non-muscle-invasive bladder cancer (NMIBC). Searching PubMed, Embase, and Scopus from inception through August 2026, researchers identified two randomized controlled trials—DaBlaCa-15 and UroFollow—enrolling 606 participants, of whom 590 contributed to the primary comparative analyses.

Biomarker-guided surveillance led to substantial reductions in procedural burden, decreasing cystoscopy utilization by 55.8% in DaBlaCa-15 and 74.9% in UroFollow. In exploratory random-effects meta-analyses, there was no significant difference between biomarker-guided and standard surveillance in the risk of any recurrence (RR 1.04, 95% CI 0.77–1.41), high-grade recurrence or disease progression (RR 1.03, 95% CI 0.61–1.74), or progression to muscle-invasive or metastatic disease (RR 0.57, 95% CI 0.12–2.67).

The authors concluded that while biomarker-guided surveillance substantially decreases cystoscopy use without evidence of worse recurrence or progression rates, formal non-inferiority could not be established. The overall evidence base remains small, patient risk groups and surveillance protocols differed across the trials, and progression events were infrequent, indicating that larger randomized trials with longer follow-up are needed before biomarker-guided protocols can replace standard guideline-based cystoscopy.