Case 1: Carl (64 years old)

Carl, a 64-year-old IT analyst, develops videogames as a hobby. His latest game is about a gnome who has to collect as many carrots as possible in a post-apocalyptic world where rabbits dominate the world.

He presented with episodes of macroscopic haematuria evolving for 1 year.

Assessment summary:

• Medical history:
  • Diabetes, treated with metformin
  • Hypertension, treated with ramipril
  • Former smoker (30 years)
• Family history: sister with breast cancer, uncle with colon cancer
• Creatinine level: 55 µmol/l, estimated GFR (eGFR): 105 ml/min
• MRI: bladder polyp
• CT urogram: no concomitant upper tract tumour
• Transurethral resection of bladder tumour (TURBT):
  • Tumour close to a ureteral orifice
  • Muscle in specimen
  • pT1 high-grade (HG) urothelial carcinoma (UCa) + carcinoma in situ (CIS)
• Second TURBT:
  • 3 papillary tumours
  • Muscle in specimen
  • pT1b HG UCa + CIS
• Third TURBT: no residual disease

The patient refused radical cystectomy (RC). Bacillus Calmette-Guérin (BCG) instillations for up to 3 years are planned.