Bladder cancer
NEW --- Initial treatment of MIBC

Case 3: Harvey (72 years old)

Harvey, 72 years old, has always tried to fix things himself, whether it’s a leaky tap or a creaky floorboard. 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:

  • No relevant medical history
  • 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: no hydronephrosis
  • eGFR: 70 ml/min
  • No peripheral neuropathy
  • No hearing impairment
  • ECOG PS: 0
  • Cardiac ejection fraction: 60%
  • No voiding symptoms

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