All of the treatment op ons shown may be appropriate. The selec on of therapy
should be individualized based on pa ent eligibility and the availability of the therapy
at the discre on of the trea ng physician.
(1) Low Risk: solitary, primary low-grade Ta tumor.
(2) Intermediate Risk: histologically-confirmed mul ple and/or recurrent low-grade
Ta tumors.
(3) High Risk: any T1, high-grade and/or carcinoma in situ.
• Pa ent and disease reviewed by mul disciplinary team
• Staging confirmed including pathology, imaging, and risk assessmet
Diagnos
c
Workup
Pa
ent
Selec
on
Treatment
Recommenda
ons
Low Risk High Risk
Intravesical therapy:
Primary op on: BCG
induc on and at least
1 year maintenance
Other op ons:
Observa on or intravesical
chemotherapy (induc on
± maintenance)
Any T1, Ta high
grade and/or CIS
Intravesical therapy:
Primary op on: BCG
induc on and 3 year
maintenance
Other op ons: Intravesical
chemotherapy (induc on
and maintenance) or
clinical trial
1
Intermediate Risk
2
3
Ta low grade
0 1–2 ≥3
Observa on
(a er
immediate post
TUR intravesical
chemotherapy)
Figure 1. Treatment Algorithm for Non-Muscle Invasive
Bladder Cancer
How many of the following
does the pa ent have?
• Mul ple tumors
• Tumor size >3 cm
• Early recurrence (<1 year)
• Frequent recurrences (>1 per year)
Repeat
TUR for
all T1HG
and
select
TaHG/CIS
pa ents
