Upper Tract Urothelial Carcinoma: A Narrative Review of Current Surveillance Strategies for Non-Metastatic Disease

Simple Summary Upper tract urinary carcinoma (UTUC) is a rare type of cancer affecting the urinary system. Patients with UTUC often undergo surgeries like kidney-sparing surgery or radical nephroureterectomy. However, even after treatment, there remains a risk of the cancer recurring in different parts of the body. This narrative review aims to better understand the frequency and locations of such recurrences, which is crucial for effectively monitoring patients after their initial treatment. Currently, there is limited information on the optimal methods for tracking patients post-surgery, and on how early detection of cancer, before the appearance of symptoms, might improve health outcomes. This article presents the most important current guideline recommendations and elucidates the evidence behind them. Exploring new imaging technologies and improving methods for assessing patient risk, can potentially lead to more personalized and effective monitoring plans in the near future.Abstract Non-metastatic upper urinary tract carcinoma (UTUC) is a comparatively rare condition, typically managed with either kidney-sparing surgery (KSS) or radical nephroureterectomy (RNU). Irrespective of the chosen therapeutic modality, patients with UTUC remain at risk of recurrence in the bladder; in patients treated with KSS, the risk of recurrence is high in the remnant ipsilateral upper tract system but there is a low but existent risk in the contralateral system as well as in the chest and in the abdomen/pelvis. For patients treated with RNU for high-risk UTUC, the risk of recurrence in the chest, abdomen, and pelvis, as well as the contralateral UT, depends on the tumor stage, grade, and nodal status. Hence, implementing a risk-stratified, location-specific follow-up is indicated to ensure timely detection of cancer recurrence. However, there are no data on the type and frequency/schedule of follow-up or on the impact of the recurrence type and site on outcomes; indeed, it is not well known whether imaging-detected asymptomatic recurrences confer a better outcome than recurrences detected due to symptoms/signs. Novel imaging techniques and more precise risk stratification methods based on time-dependent probabilistic events hold significant promise for making a cost-efficient individualized, patient-centered, outcomes-oriented follow-up strategy possible. We show and discuss the follow-up protocols of the major urologic societies.