A 58-year-old man presents with painless total haematuria. Cystoscopy reveals a papillary tumour at the right lateral wall. TURBT shows pT1 high-grade urothelial carcinoma with no muscularis propria invasion. What is the MOST appropriate next management step?
- A Radical cystectomy as the tumour is high-grade
- B Repeat TURBT within 6 weeks followed by intravesical BCG immunotherapy ✓
- C Single dose intravesical mitomycin C immediately post-TURBT and surveillance cystoscopy
- D Neoadjuvant cisplatin-based chemotherapy before cystectomy
Correct answer: B. Repeat TURBT within 6 weeks followed by intravesical BCG immunotherapy
Explanation
For pT1 high-grade non-muscle-invasive bladder cancer (NMIBC), guidelines recommend a re-TURBT within 4-6 weeks (to ensure complete resection and accurate T-staging, as upstaging to muscle-invasive disease is found in 10-15% of cases) followed by induction intravesical BCG immunotherapy. BCG significantly reduces recurrence and progression risk in high-grade T1 tumours. Immediate instillation of mitomycin C is appropriate for low-risk Ta disease but insufficient for T1 high-grade.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.