A 70-year-old male presents with gross hematuria. Cystoscopy reveals a sessile, non-papillary bladder mass. Transurethral resection biopsy shows T2 disease (muscle-invasive bladder cancer). According to standard management, what is the most appropriate next step?
- A Neoadjuvant cisplatin-based chemotherapy followed by radical cystectomy ✓
- B Intravesical BCG immunotherapy
- C Radical radiotherapy alone
- D Repeat TURBT and surveillance
Correct answer: A. Neoadjuvant cisplatin-based chemotherapy followed by radical cystectomy
Explanation
Muscle-invasive bladder cancer (T2 or higher) is managed with radical cystectomy as the gold standard. Neoadjuvant cisplatin-based combination chemotherapy (e.g., MVAC or gemcitabine-cisplatin) administered before cystectomy has shown an absolute overall survival benefit of approximately 5–8% and is recommended by major guidelines (EAU, NCCN) for eligible patients. Intravesical BCG is appropriate for non-muscle-invasive high-risk disease only.
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.