From Guidelines to Real Life—Multidisciplinary Insights for Optimizing Intravesical Bacillus Calmette–Guérin (BCG) Therapy in NMIBC

Intravesical Bacillus Calmette–Guérin (BCG) therapy remains the mainstay of treatment for high-risk non-muscle-invasive bladder cancer (NMIBC), yet suboptimal adherence and underutilization of maintenance therapy limit real-world outcomes. This commentary summarizes multidisciplinary insights from an expert symposium at the European Association of Urology 2026 meeting, focusing on practical strategies to optimize treatment delivery. Key themes included the critical role of patient education, proactive toxicity management, and consistent multidisciplinary communication in improving adherence to prolonged BCG regimens. Treatment-related adverse events were identified as a major driver for discontinuation, although evidence suggests that true biologic intolerance to BCG is uncommon when best practices are implemented. Substantial clinical evidence indicates that maintenance BCG, rather than induction therapy alone, is necessary to reduce recurrence and progression risk.