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

Oswald (75 years old)

Oswald, a 75-year-old retired theater director who enjoys scriptwriting, was initially diagnosed with intermediate-risk NMIBC. He received BCG for 1 year.

Follow-up cystoscopy 3 months after completion of BCG shows a 1.5 cm papillary tumour at the anterior bladder wall.

Assessment summary:

  • Medical history:
    • Former smoker (40 pack years)
    • Hypertension, peripheral artery disease (PAD)
  • ECOG PS: 1
  • Urine cytology: suspicious for HG UCa (according to the Paris system)
  • Conventional TURBT: resection visually complete, pathological review:
    • pT1 HG
    • Pure UCa
    • No LVI
    • Muscle in specimen
  • Second TURBT: no residual disease
  • CT urography: cN0, no concomitant upper tract tumour

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