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

Logan (73 years old)

Logan, 73 years old, spent years maintaining a remote lighthouse, ensuring ships stayed safe. He was diagnosed with intermediate-risk NMIBC 4.5 years ago and was treated with TURBT followed by intravesical chemotherapy for 1 year.

Follow-up cystoscopy 3 years after the final course of intravesical chemotherapy shows multiple reddish lesions at the anterior bladder wall.

Assessment summary:

  • Medical history:
    • Former smoker (50 pack years)
    • Hypertension, obesity, diabetes mellitus type 2
  • ECOG PS: 1
  • Urine cytology: HG UCa (according to the Paris system)

On TURBT urothelial CIS was detected. A CT urography ruled out nodal and upper tract involvement.

BCG induction was started and followed by maintenance BCG. CIS is present 3 months after the start of BCG (i.e. BCG induction completed) and persists at 6 months (i.e. first course of maintenance completed).

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