Version July 2025
AUA: American Urological Association; BCG: Bacille Calmette-Guérin; CIS: carcinoma in situ; EORTC: European Organisation for Research and Treatment of Cancer; NMIBC: non-muscle invasive bladder cancer; Ta: papillary tumor; TURBT: transurethral resection of bladder tumor.
* Resection is not visually complete, tumor is high-volume, and/or muscularis propria is absent in the histologic specimen.
¶ Refer to UpToDate content on the management of muscle-invasive bladder cancer.
Δ An EORTC recurrence score calculator is available at: www.eortc.be/tools/bladdercalculator/default.htm.
◊ Appropriate alternatives include intravesical mitomycin, epirubicin, and pirarubicin.
§ Low-risk tumors are monitored with cystoscopy. Intermediate- and high-risk tumors are monitored with urine cytology cystoscopy and imaging of the upper urinary tract. Patients who smoke should be encouraged to quit. For further details and surveillance schedules, refer to UpToDate content on initial treatment of primary NMIBC.
¥ Gemcitabine is the preferred option for induction and maintenance intravesical chemotherapy. Other options for intravesical therapy include epirubicin or mitomycin. However, intravesical mitomycin is less preferred since it is significantly more toxic than gemcitabine. Although intravesical BCG is an effective alternative, it is also less preferred since disease progression is infrequent in intermediate-risk disease, it is more toxic, and availability is limited due to an ongoing BCG shortage.
‡ Alternative treatments for select tumors include:† Although the AUA does not formally define this subcategory, the guidelines do acknowledge a subset of patients with additional features that place them at the highest risk for disease progression.
