Difficult decisions in urologic oncology: Management of high-grade T1 transitional cell carcinoma of the bladder

Management decisions for a patient with high grade (G3) T1 urothelial cancer of the bladder are critical. These tumors should not be classified as “superficial” since they are not confined to the urothelium. Patients with T1G3 bladder cancers are likely to have recurrence and the tumor will often progress, invade, metastasize, and cause death. Radical cystectomy as well as transurethral resection followed by intravesical BCG are acceptable initial therapies. This article reviews these treatment options and provides recommendations for management of high grade T1 tumors.