The optimal management of T1 high-grade bladder cancer

Stage T1Hg bladder cancer should be considered an aggressive andpotentially lethal disease. The importance of initial re-resection toidentify unrecognized muscle-invasive disease is significant. Mostpatients with high-risk disease are candidates for initial bladder salvagewith intravesical bacillus Calmette-Guerin vaccine forimmunotherapy, a procedure with a high survival rate; however,failure of the procedure may result in a guarded prognosis. Evenafter apparent success, patients should be informed of the risks ofthe disease progressing to muscle-invasive or metastatic diseaseand the need for vigilant monitoring. Despite optimal management,a significant number of patients relapse or progress to invasive diseaserequiring cystectomy. This review provides insight into theoptimal management of T1 high-grade bladder cancer.