A 50-year-old man is evaluated for painless gross hematuria. Cystoscopy reveals a 3 cm papillary tumor on the posterior bladder wall. TURBT pathology shows urothelial carcinoma invading the muscularis propria (T2). Staging CT shows no lymphadenopathy or distant metastases. What is the standard of care treatment?
- A Repeat TURBT + intravesical BCG immunotherapy
- B Radical cystectomy with neoadjuvant cisplatin-based chemotherapy ✓
- C Radical radiotherapy alone with curative intent
- D TURBT alone with 3-monthly surveillance cystoscopy
Explanation
Muscle-invasive bladder cancer (MIBC, T2 and above) is treated with radical cystectomy (cystoprostatectomy in men, anterior exenteration in women). Neoadjuvant cisplatin-based chemotherapy (MVAC or GC regimen) provides a significant survival benefit — the Grossman et al. trial showed a 5-year survival improvement from 43% to 57% with neoadjuvant MVAC. BCG and intravesical therapy are for non-muscle-invasive disease (Ta, T1, CIS). Bladder-preserving trimodality therapy (TURBT + concurrent chemo-radiation) is an alternative for carefully selected patients who refuse or cannot tolerate cystectomy.
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.