When bladder cancer treatment ends, follow-up care begins. The appointments after treatment are an essential part of your ongoing care. Bladder cancer has one of the highest recurrence rates, which means monitoring closely after treatment gives you the best chance of catching changes early. Your exact schedule may vary based on your stage, grade, and overall health, but here’s what monitoring typically looks like.
After bladder removal (radical cystectomy)
A radical cystectomy removes the bladder (and sometimes nearby lymph nodes and organs). Even after the bladder is removed, surveillance is still very important because cancer can come back in other parts of the body or in the urinary tract.
Monitoring for recurrence with muscle-invasive bladder cancer typically includes physical exams, imaging scans, blood tests, and additional tests to assess your liver and kidney health. Your care team will also ask about symptoms and check your overall health.
Below are tests the NCCN Guidelines® recommend after initial treatment.
Imaging scans
Imaging scans help look for recurrence elsewhere in the body:
- CT scans of the chest, abdomen, and pelvis (or MRI in some cases)
- Typically every 3-6 months for the first two years
- Spaced out once a year if everything remains stable
- An ultrasound of your kidneys once a year after 6 years
The highest risk of recurrence is usually within the first 2–3 years, which is why imaging is more frequent early on.
Blood tests
In addition to imaging scans, you’ll likely have blood tests every 3-6 months for the first year or so. The blood tests will look at your kidney and liver function. If you’ve had chemotherapy, your care team will also order a complete blood count and a complete metabolic panel.
After the first year, the NCCN Guidelines recommend blood tests once a year to continue monitoring kidney and liver function. Your care team may also suggest tests to monitor your B12 levels.
Urine tests
A urine cytology (a type of urine screening) will help detect any cancer cells in your urine. If you’re at high risk for recurrence, monitoring with urethral wash cytology is also recommended. Current guidelines recommend these urine tests every 6-12 months for the first two years. The frequency after two years is up to you and your care team.
After bladder preservation (bladder-sparing treatment)
Bladder preservation usually involves TURBT (transurethral resection of bladder tumor) followed by intravesical therapy (like BCG) or chemoradiation. In this case, your bladder remains in place, which means it must be monitored very closely.
Cystoscopy
This is a procedure where a thin camera is inserted into the bladder to look directly at the lining.
The typical schedule is:
- Every 3 months for the first 2 years
- Every 6 months for years 3–4
- Annually after year 4
Imaging of the upper urinary tract
Bladder cancer can recur in the ureters or kidneys, so imaging (CT, MRI, chest x-ray) is recommended every 3-6 months for the first two years. The frequency drops to annually after year two.
If there’s a chance of metastasis, an FDG PET /CT scan is recommended.
Blood tests
Current guidelines recommend blood tests every 3-6 months for the first year to check your kidney and liver function. After the first year, your doctor will determine the frequency of blood tests.
Urine tests
Often done at the same time as cystoscopy, guidelines recommend a urine test every 6-12 months for the first two years.
Why is follow-up so structured?
Keeping up with regular follow-up appointments and building an ongoing relationship with your care team is one of the most powerful ways to stay ahead of a possible recurrence. If anything feels off, Fox Chase Cancer Center’s Dr. Elizabeth Plimack emphasizes that it’s essential not to ignore your symptoms.
This period can stir up a lot of anxiety and take a toll on your emotional health. Dr. Plimack recommends finding a patient advocacy group for support and community. She acknowledges that “there’s some amount [of anxiety] that just comes with this,” but try to be in a positive mindset. She adds, “If you’re really struggling with that, getting specialty care with a therapist with experience with [recurrence] is always helpful.”
If you’re ever unsure why a test is being ordered or how long you’ll need surveillance, don’t be afraid to ask questions. Understanding your follow-up plan can help you feel more in control.
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