Initial management of non-muscle invasive bladder cancer

TURBT: transurethral resection of bladder tumor; CIS: carcinoma in situ; Ta: papillary tumor; BCG: Bacillus Calmette-Guerin.
* This risk stratification scheme is generally consistent with guidelines from the European Association of Urology (EAU).
¶ Restaging TURBT is indicated for all high-grade T1 lesions and select patients with high-grade Ta disease. Restaging needs to demonstrate absence of distant involvement at time of local recurrence if salvage cystectomy is to be done.
Δ Indications for radical cystectomy include extensive bladder involvement with inability to attain complete resection of all visible disease despite multiple attempts at TURBT; men with CIS involving the prostatic ducts/acini; pure squamous cell or adenocarcinoma histology; T1 tumor with lymphovascular invasion or variant histology, such as micropapillary, neuroendocrine/small cell, or sarcomatoid features; T1 grade 3 tumors that are large/diffuse/multifocal or persistent lesions identified on re-resection; and T1b tumors (ie, deep or extensive involvement of the lamina propria). For T1 high-grade tumors with CIS, the use of radical cystectomy is controversial. Refer to UpToDate content on treatment of primary non-muscle invasive bladder cancer.
◊​ Careful follow-up is required for all patients with non-muscle invasive bladder cancer including the bladder, renal pelvis, ureters, and urethra for patients with intermediate- or high-risk disease. For those with low-risk disease, surveillance of the upper urinary tract is not indicated. The frequency and intensity of follow-up should consider the risk of recurrence. In addition to cystoscopy, follow-up may include urine cytology and evaluation of the upper urinary tract.