FIG. 21:  As seen in the left panel (A) in this Figure, the disease-specific mortality (DSM) rate by 10 years in these low-risk patients was less than the overall morality from other causes.^[22]  When we looked at only the 2.4% of patients with DSM in the right panel (B), these deaths fell into 3 distinct groups: 

• Patients who died within 12–24 months of invasive bladder cancer, meaning their physicians probably misdiagnosed or missed a more aggressive disease, whilst picking up the low-grade noninvasive tumor.
• Patients with gradually progressive disease who had a number of treatments over the next 5 years, starting with intravesical chemotherapy, moving to intravesical immune BCG therapy, and eventually more radical treatment. In that population with progressive disease and treatment, deaths occurred over the following 5 years. 
• A third population of patients with bladder cancer who continued being followed up with surveillance, with no recurrence and no problems until they suddenly presented with progression and metastatic disease after 5 years. Despite all the energy spent on disease surveillance, we were unable to keep those patients alive.