Rethinking Recurrent LG Ta Bladder Cancer: A Multicenter Analysis of Oncological Safety and Treatment Burden in Patients Undergoing Active Surveillance or Office-Based Fulguration

PURPOSE: To compare oncological outcomes and treatment burden between active surveillance and office-based fulguration in patients with recurrent low-grade Ta non-muscle-invasive bladder cancer. MATERIALS AND METHODS: We performed a retrospective multicenter study including patients with recurrent papillary tumors clinically consistent with low-grade Ta bladder cancer managed with active surveillance or office-based fulguration between 2013 and 2025 at three centers. Primary endpoints were grade and stage progression-free survival. Secondary endpoints included cystectomy-free survival, transurethral resection-free survival, and cumulative treatment burden. Kaplan-Meier analyses, Cox regression, and negative binomial regression models were used for statistical evaluation. CONCLUSIONS: In selected patients with recurrent low-grade Ta bladder cancer, active surveillance and office-based fulguration demonstrated comparable oncological safety. However, active surveillance was associated with a significantly lower cumulative treatment burden, supporting its role as a de-escalation strategy.