Case 4: Leo (72 years old)

Leo, a 72-year-old retired architect, has spent his life designing spaces meant to last, balancing creativity with precision. Now in his seventies, he values quiet mornings, family gatherings. He was diagnosed with high-grade NMIBC and underwent 6 cycles of BCG. At follow-up cystoscopy, a tumour was found at the bladder neck.

Assessment summary:

• Maximal TURBT, resection visually complete
• Pathological review:
  • Progression to MIBC, at least pT2
  • Pure urothelial carcinoma (UCa)
  • Unifocal, no concomitant CIS
  • Muscle in specimen
• Imaging: suggestive for cT2N0M0
• Ultrasound: bilateral hydronephrosis
• eGFR: 70 ml/min
• No peripheral neuropathy
• No hearing impairment
• ECOG PS: 0
• Cardiac ejection fraction: 60%
• No relevant medical history
• No voiding symptoms