The EAU (European Association of Urology) guidelines classify non-muscle-invasive bladder cancer (NMIBC) into risk groups. Which feature most strongly indicates high-risk NMIBC requiring BCG maintenance therapy?

• A Single pTa low-grade tumor less than 3 cm
• B Any pT1 high-grade tumor or carcinoma in situ (CIS) ✓
• C Recurrent pTa low-grade tumor or multiple pTa low-grade tumors
• D pTa high-grade tumor without CIS in a treatment-naïve patient

Explanation

EAU guidelines define high-risk NMIBC as: any pT1 high-grade (G3) tumor, any carcinoma in situ (CIS), or pTa G3/high-grade tumors, and multiple/recurrent/large pT1 G2 tumors. High-risk NMIBC requires intravesical BCG induction plus maintenance therapy (Lamm or SWOG schedule) to reduce recurrence and progression. CIS specifically has a 54% risk of progression to muscle-invasive disease without treatment, making it the most critical indicator. BCG failure in high-risk NMIBC warrants consideration of radical cystectomy.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.