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

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

doi:10.1038/s41585-026-01137-8

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

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

Roberto Contieri, Paolo Gontero, Rodolfo Hurle, Luca Afferi, Simone Albisinni, Marek Babjuk, Alison Birtle, Peter Black, Maurizio Brausi, Max Bruins, …

Nature reviews. Urology

04/01/2026

DOI: 10.1038/s41585-026-01137-8

PMID: 41922791

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Abstract

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.

Details

Title: Subtitle: Active surveillance in low-grade NMIBC - results of an international two-round modified Delphi consensus
Creators: Roberto Contieri - Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale"
Paolo Gontero - Fondazione Ricerca Molinette
Rodolfo Hurle - Humanitas University
Luca Afferi - Kantonsspital Aarau
Simone Albisinni - University of Rome Tor Vergata
Marek Babjuk - Charles University
Alison Birtle - University of Lancashire
Peter Black - University of British Columbia
Maurizio Brausi - Hesperia Hospital
Max Bruins - Zuyderland Medisch Centrum
Otakar Čapoun - Charles University
Albert Carrion - Universitat Autònoma de Barcelona
James Catto - University of Sheffield
Ananya Choudhury - The Christie NHS Foundation Trust
Alessia Cimadamore - University of Udine
Eva Comperat - Medical University of Vienna
Siamak Daneshmand - University of Southern California
David D'andrea - Medical University of Vienna
Francesco Del Giudice - Policlinico Umberto I
Jose Luis Domínguez Escrig - Fundación Instituto Valenciano de Oncología
Patrick Hensley - University of Kentucky
Wojciech Krajewski - Wroclaw Medical University
Ekaterina Laukhtina - Comprehensive Cancer Center Vienna
Roger Li - Moffitt Cancer Center
Fredrik Liedberg - Lund University
Yair Lotan - The University of Texas Southwestern Medical Center
Gautier Marcq - Université de Lille
Paramananthan Mariappan - Western General Hospital
Andrea Mari - University of Florence
Alberto Martini - University of Cincinnati Medical Center
Alexandra Masson Lecomte - Université Paris Cité
Richard Meijer - University Medical Center Utrecht
Maria Carmen Mir - Elmhurst Hospital Center
Keiichiro Mori - Jikei University School of Medicine
Marco Moschini - IRCCS Ospedale San Raffaele
Hugh Mostafid - Royal Surrey County Hospital
Micheal O'Donnell - University of Iowa
Joan Palou - Puigvert Foundation
Valeria Panebianco - Sapienza University of Rome
Sisto Perdonà - Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale"
Sima Porten - University of California, San Francisco
Sarah Psutka - Fred Hutch Cancer Center
Michael Rink - Marienkrankenhaus Hamburg
Morgan Roupret - Sorbonne Université
Thomas Seisen - Sorbonne Université
Mark Soloway - Memorial Healthcare System
Viktor Soukup - Charles University
Gary Steinberg - Rush University Medical Center
Arnulf Stenzl - University of Tübingen
Jeremy Yc Teoh - Chinese University of Hong Kong
Karl Tully - Universitätsklinik Marien Hospital Herne
Toine van der Heijden - Radboud University Nijmegen
Bas W G van Rhijn - The Netherlands Cancer Institute
Alfred Witjes - Radboud University Nijmegen
Evanguelos Xylinas - Université Claude Bernard Lyon 1
Ashish M Kamat - The University of Texas MD Anderson Cancer Center
Benjamin Pradere - Department of Urology, La Croix Du Sud Hospital, Quint-Fonsegrives, France
Laura S Mertens - The Netherlands Cancer Institute
Resource Type: Journal article
Publication Details: Nature reviews. Urology
DOI: 10.1038/s41585-026-01137-8
PMID: 41922791
NLM abbreviation: Nat Rev Urol
ISSN: 1759-4820
eISSN: 1759-4820
Publisher: Nature Publishing Group
Language: English
Electronic publication date: 04/01/2026
Academic Unit: Urology
Record Identifier: 9985149578002771

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