Risk category Definition Treatment Surveliance

recommendation
Low-risk Primary, solitary, TaG1 One immediate instillation Cystoscopy at 3,12 mo
tumours (PUNLMP, LG), < 3 cm, of intravesical then yearly up to 5 yrs
no CIS chemotherapy after TURB.

Intermediate- All tumours not defined in In patients with previous in-between

risk the two adjacent low recurrence rate (less (individualised) follow-up
tumours categories (between the than or equal to one scheme using
category of low and high recurrence per year) and cystoscopy.
risk). expected EORTC
recurrence score < 5, one
immediate instillation of
intravesical chemotherapy
after TURB. In all patients
either one-year full-dose
BCG treatment (induction
plus three-weekly
instillations at three, six and
twelve
months), or instillations of
chemotherapy (the optimal
schedule is not known) for a
maximum of one year.
High-risk Any of the following: Intravesical full-dose BCG  Cystoscopy +
tumours 1) T1 tumours; instillations for one to three cytology every
2) G3 (HG) tumour; years or radical cystectomy 3 mo up to 2 yr
3) CIS; then every 6
4) Multiple, month till 5 yr,
recurrent and then yearly
large (> 3 cm)  Regular (yearly)
TaG1G2/LG upper tract
tumours (all imaging
features must be (computed
present). tomography-
intravenous
urography [CT-
IVU] or IVU)
Subgroup of highest-
risk tumours
 T1G3/HG  Radical
associated with cystectomy should
concurrent be considered.
bladder CIS,  In those who
 multiple and/or refuse or are unfit
largeT1G3/HG for RC intravesical
and/or recurrent full-dose BCG
T1G3/HG instillations for one
 , T1G3/HG with to three years
CIS in the
prostatic urethra,
 some forms of
variant histology
of urothelial
carcinoma, LVI
BCG-refractory tumours. Radical cystectomy is
recommended.