A 55 year old male presented with painless terminal hematuria. Cystoscopic examination revealed a solitary papillary tumor, histopathological of completely resected tumor is suggestive of grade III transitional cell carcinoma with no muscle invasion. Which of the following is the next best step in management?
Patient in the question stem is suffering from T1 grade III transitional cell carcinoma with no muscle invasion. He has undergone resection of the tumor, so the next best step in the management is intravesical instillation of BCG. Treatment of high grade non muscle invasive bladder cancer (Ta,T1,carcinoma in situ) is transurethral resection followed by intravesical immunotherapy with BCG. When compared to intravesical chemotherapy, BCG was found to prevent tumor recurrence in 43%cases, and was also found to decrease the risk of tumor progression. Ref: Bladder Tumors: Molecular Aspects and Clinical Management By Vinata B. Lokeshwar, Page 304; Carcinoma of The Bladder By David MacVicar, Page 42 3. Radiology Illustrated: Uroradiology By Seung Hyup Kim, 2nd Edition, Page 256.
Follow up
Cystectomy
Intravesical BCG
Intravesical chemotherapy