Bladder cancer

Challenges in high-risk NMIBC

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Educational Objective: Gain insight on individual treatment strategies for (very) high-risk non-muscle-invasive bladder cancer (NMIBC) in Bacillus Calmette-Guérin (BCG) naïve patients and after BCG failure.
Specialty: Urology, Medical oncology
Target Audience: CME (basic, intermediate), Residents (senior)
Latest update: May 2022

The EAU and AUA/SUO guidelines recommend the stratification of patients with NMIBC into risk groups based on their probability of progression to muscle-invasive disease [1,2].

The EAU risk stratification consists of 4 risk groups (low, intermediate, high and very high) and takes into account, on top of stage and grade, the following clinical risk factors [1]:

  • Age >70 years
  • Multiple papillary tumours
  • Tumour diameter >3 cm

Meanwhile, the AUA risk stratification for NMIBC consists of 3 risk groups (low, intermediate and high) [2].

(Very) High-risk NMIBC according to the EAU and AUA guidelines

Regulatory approval status of drugs for high-risk BCG-unresponsive NMIBC (status 1 December 2021)


  1. Babjuk M, Burger M, Compérat E, et al. European Association of Urology (EAU) guidelines on non-muscle-invasive bladder cancer (TaT1 and CIS). Update March 2022. Available at:
  2. Chang SS, Boorjian SA, Chou R, et al. Diagnosis and treatment of non-muscle invasive bladder cancer: American Urological Association (AUA)/Society of Urologic Oncology (SUO) guideline. Update 2020. Available at: