A second look at the pT1 G3 bladder tumour

People with pT1 G3 bladder cancer are at high risk of tumour progression and death. Induction and maintenance intravesical Bacillus Calmette-Guerin (BCG) has been proven to reduce tumour progression in superficial bladder cancer at moderate risk of progression. By extrapolation, this treatment is often now given for pT1 G3 bladder cancer. Phase II studies published over the past 10 years on the use of adjuvant intravesical BCG following transurethral resection (TUR) of the tumour(s) suggest an important effect on the number of patients progressing. The data are mixed, however. A randomised study of the use of adjuvant radiotherapy in pT1 G3 bladder cancer has shown that it is not of benefit and that, overall, the progression rate remains high. Early cystectomy for high-risk cases is not commonly used, and its results are often disappointing, presumably a consequence of negative selection. Identification of patients at extra high risk of progression is desirable. Tumour size, the co-existence of carcinoma in situ and early tumour recurrence may be prognostic indicators, but the data are at present insufficient.