Treatment for T1G3 Tumor

High-grade T1 (formerly T1G3) bladder cancer has a poor prognosis due to a higher incidence of recurrence and progression than other non-muscle-invasive bladder cancers; thus, patients with high-grade T1 bladder cancer have to be carefully monitored and managed. Bacillus Calmette–Guerin (BCG) immunotherapy after transurethral resection (TUR) of bladder tumor is currently viewed as a gold standard for conservative therapy for T1G3 tumors. However, there remains a debate regarding the use of immediate prophylactic posttransurethral resection chemotherapy instillation for high-grade T1 bladder cancer. The secondary TUR is important because of its diagnostic and therapeutic benefits. If patients with high-grade T1 bladder cancer have a low risk of progression, adjuvant intravesical BCG immunotherapy is the treatment of choice for bladder preservation. In contrast, for high-risk patients, immediate or early cystectomy might offer the best opportunity for cure; however, early cystectomy is associated with morbidity and a risk of mortality, and it might constitute potential overtreatment for many cases of high-grade T1 bladder cancer.