Bladder cancer
Initial treatment of MIBC

Joaquin (65 years old)

Joaquin is a 65-year-old university professor who enjoys going karting with his grandson. He recently underwent cystoscopy for painless haematuria, which revealed a papillary tumour.

Assessment summary:

  • Medical history: hypertension and borderline diabetes mellitus
  • Maximal TURBT, visually complete
  • Pathological review:
    • pT2 UCa
    • Unifocal, no concomitant CIS
  • CT imaging of chest, abdomen and pelvis: suggestive for cT2b N0 M0
  • Ultrasound: no hydronephrosis
  • eGFR: 70 ml/min
  • No peripheral neuropathy
  • No hearing impairment
  • ECOG PS: 0
  • Cardiac ejection fraction: 65%

The patient completed 4 cycles of neoadjuvant gemcitabine + cisplatin with CR.

  • MRI of abdomen/pelvis combined with chest CT imaging: suggestive for cT0 cN0 cM0
  • Cystoscopy with TUR biopsies: no residual tumour

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