The European Association of Urology (EAU) has updated its guidelines on the management of non-muscle-invasive bladder cancer (NMIBC), TaT1, and carcinoma in situ (CIS).
Key among the recommendations are the following:
- TaT1 and/or CIS are grouped under the heading of NMIBC.
- In papillary lesions, complete TURB is essential.
- Where the initial resection is incomplete, where there is no muscle in the specimen, or where a T1 tumour is detected, a second TURB should be performed within 2-6 weeks.
- The European Organisation for Research and Treatment of Cancer (EORTC) scoring system can be used to estimate risks of both recurrence and progression.
- One immediate chemotherapy instillation is recommended for patients with tumours presumed to be at low risk and in those presumed to be at an intermediate risk with a low previous recurrence rate and an expected EORTC recurrence score of
- Patients with intermediate-risk tumours should receive 1 year of full-dose bacillus Calmette-Guérin (BCG) intravesical immunotherapy or instillations of chemotherapy for a maximum of 1 year.
- Full-dose intravesical BCG for 1-3 yr is indicated for patients with high-risk tumours.
- In patients at the highest risk of tumour progression, immediate radical cystectomy should be considered.
- Cystectomy is recommended in BCG-unresponsive tumours.
The extended version of the guidelines is available here.