Bladder cancer
Management of BCG-pretreated (very) high-risk NMIBC

Hiram (68 years old)

Hiram is a 68-year-old retired veterinarian who enjoys playing the harmonica. He presented with episodes of macroscopic haematuria.

Assessment summary:

  • Medical history: obesity, diabetes mellitus type 2
  • ECOG PS: 1
  • Cystoscopy: papillary tumour of 2 cm at the right bladder wall, multiple reddish lesions
  • Urine cytology: HG UCa (according to the Paris system)
  • Conventional TURBT: resection visually complete, pathological review:
    • pT1 HG + CIS
    • Pure UCa
    • No LVI
    • Muscle in specimen
  • Second TURBT: CIS
  • CT urography: cN0, no concomitant upper tract tumour

BCG induction was started. Follow-up cystoscopy at 3 months (i.e., BCG induction completed) shows a 1 cm papillary tumour. Conventional TURBT confirms pTa low-grade (muscle in specimen, no LVI).

Which of the following options would you choose for this patient?