A 45-year-old man presents with macroscopic haematuria. Cystoscopy reveals a 2 cm sessile lesion at the bladder trigone. TURBT histology confirms high-grade T1 urothelial carcinoma with carcinoma in situ (CIS). After re-TURBT confirms T1 high-grade with CIS, what is the MOST appropriate next definitive management?
- A Intravesical BCG induction course followed by maintenance
- B Intravesical mitomycin C single instillation
- C Radical cystectomy ✓
- D External beam radiotherapy with concurrent cisplatin
Explanation
High-grade T1 bladder cancer with concomitant CIS represents the highest-risk non-muscle-invasive bladder cancer (NMIBC) category and carries a ~50% risk of progression to muscle-invasive disease. European Association of Urology (EAU) guidelines recommend radical cystectomy as the preferred treatment for this highest-risk group, particularly when CIS is present alongside high-grade T1 after adequate re-TURBT confirms the stage. BCG maintenance is an option for intermediate and some high-risk NMIBC, but T1 high-grade with CIS represents a group where early cystectomy is the gold standard to prevent progression.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.