Non-Muscle Invasive Bladder Cancer:

AUA/SUO Treatment Algorithm

Bladder Cancer: Non-Muscle Invasive

Bladder Cancer: Non-Muscle Invasive

Complete Recurrence
Postoperative response within 1 year Reassess as
Low Risk Surveillance
Chemo Int. Risk*

Partial or no response

Induction Complete response

Chemo

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