Optimal management of the T1G3 bladder cancer

Management decisions for a patient with a high-grade T1 urothelial cancer of the bladder are both critical and controversial. In the authors' view, if one uses a grading scale of 0 to 10 for difficulty in decision making (10 being the most difficult), the patient with T1G3 tumor rates a 10. By definition, these high-grade bladder tumors invade the lamina propria without involving the muscularis propria [1]. They have high propensity for recurrence and progression. Following transurethral resection (TURBT) of the initial T1G3 tumor with no additional therapy, there is a recurrence rate of 50% to 70% and a progression rate of 25% to 50% [2,3]. The optimal management of these tumors requires an accurate diagnosis including the stage and grade, and careful assessment of prognostic factors. The wide range of available treatment options includes TURBT alone, adding intravesical therapy, radical cystectomy, and even possibly chemoradiation. Despite advances in the understanding of the biologic behavior of these tumors, both the choice and timing of treatment remain controversial [3].