Patients with non-muscle-invasive bladder cancer (NMIBC) have high rates of tumor recurrence and disease progression. In patients with low-risk NMIBC (LR-NMIBC), the risk of recurrence decreases over time following the first year and remains consistently low after five years. We report a case of a patient with low-risk NMIBC who experienced tumor recurrence after 15 years of follow-up.

A 56-year-old man presented with gross hematuria for one month. An intravenous pyelography revealed a filling defect in the urinary bladder. Cystoscopy showed a cauliflower-like tumor, and transurethral resection of the bladder tumor (TURBT) was performed on January 15, 2010. The final diagnosis was papillary urothelial carcinoma, low grade, pTa. The patient received intravesical chemotherapy with MDC (Mitomycin, Doxorubicin, Cisplatin) following surgery. He underwent regular follow-up with cystoscopy, urine cytology, intravenous pyelography, and renal ultrasound. However, at 15 years and 2 months of follow-up, cystoscopy revealed a small papillary tumor and multiple areas of mucosa with a ground-glass appearance [Figure 1]. Pathological examination after repeat TURBT confirmed invasive papillary urothelial carcinoma, high grade, pT1, and urothelial carcinoma in situ, high grade.

Close surveillance following treatment is essential for NMIBC due to the significant risk of tumor recurrence and progression. Some studies report that the recurrence rate for LR-NMIBC is approximately 50% within four years. Other studies suggest that the likelihood of recurrence in LR-NMIBC decreases after the first year and remains minimal beyond five years, leading to recommendations that cystoscopic follow-up may be discontinued after five years in this patient population. The EAU guidelines even suggest that discontinuation of cystoscopy, or replacement with less invasive methods, may be considered after five years of follow-up in LR-NMIBC patients. However, our case highlights the possibility of bladder cancer recurrence even after 15 years, despite its rarity, suggesting the need for prolonged follow-up in selected patients.

In LR-NMIBC, cystoscopic follow-up is often considered for discontinuation after five years. However, our case demonstrates a late recurrence at 15 years, emphasizing the importance of extended surveillance. Consistent follow-up remains crucial for the timely detection of recurrence and appropriate intervention.