How to Treat a Patient with T1 High-grade Disease and No Tumour on Repeat Transurethral Resection of the Bladder?

A relatively young (64-yr old) long-term heavy smoker but otherwise very healthy man is diagnosed with a primary unifocal left-side tumour (urothelial, T1 high grade), but no lymphovascular invasion and no variant histology. We discuss whether treatment with intravesical bacillus Calmette-Guerin vaccine will be sufficient or early radical cystectomy is at least equally preferred regarding patient benefit, safety, and quality of life. Patient summary: A patient with a single high-grade T1 bladder tumour without aggressive features (eg, lymphovascular invasion or variant tumour aspects) will be adequately treated with bacillus Calmette-Guerin intravesical therapy delivered into the bladder, followed by 3 yr of maintenance. However, all decisions should be taken with the patient in a shared decision-making process, including a discussion regarding removal of the bladder. (c) 2020 Published by Elsevier B.V. on behalf of European Association of Urology.