A 72-year-old man presents with painless haematuria. Cystoscopy reveals a 3 cm papillary bladder tumour. TURBT specimen shows high-grade urothelial carcinoma invading the muscularis propria (pT2). He has no distant metastases. The standard of care is:

• A Intravesical BCG immunotherapy
• B Radical cystectomy with neoadjuvant cisplatin-based chemotherapy ✓
• C External beam radiotherapy alone
• D Repeat TURBT followed by adjuvant intravesical mitomycin C

Explanation

Muscle-invasive bladder cancer (pT2+) requires radical cystectomy (with urinary diversion). Neoadjuvant cisplatin-based chemotherapy (MVAC or GC regimen) before cystectomy provides an approximate 5–8% absolute survival benefit per meta-analysis and is the current standard of care for eligible patients. Intravesical BCG is for high-grade non-muscle-invasive disease (pTis, pT1). Radiotherapy alone is inferior to combined modality treatment.

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.