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Non Muscle Invasive Bladder Cancer Algorithm
Non Muscle Invasive Bladder Cancer Algorithm
Partial or no response
Partial or no
response
Others
TURBT Int. Risk
Complete
response Maintenance
incomplete TUR
BCG Surveillance
(1 yr)
T1 and/or
Partial or no
response
Recurrence
Re-TURBT†
+/- Chemo Complete
response
Reinduce
≥1 yr
Partial or no
response
Complete response
<1 yr
If trial is unavailable
T1, LVI, +/- variant If unfit or unwilling to Clinical Trial
undergo surgery
Cystectomy
Intravesical
+/- variant
Chemo
T1, LVI,
no response
T1 Others Systemic
Partial or Immunotherapy
no response
Partial or
Re-
High Risk
TURBT†
+/- Chemo Complete response
Others
Reinduce
*Consider fulguration in low-volume disease recurrence; otherwise reassess as
intermediate risk.
†Timely re-TURBT (within six weeks ) should be performed if there are concerns BCG Complete response Maintenance
regarding an incomplete resection and/or if bladder sparing treatment (e.g., (3 yrs)
intravesical therapy or surveillance), is being planned.
44 ©2020 American Urological Association 45