Proactive approach to treat high-grade lamina-invasive bladder cancer

Urothelial cancer, despite advances in the field of medicine, remains an enigmatic problem with no tangible solution to treat it once it goes beyond the detrusor muscle. Nonmuscle-invasive bladder cancer form the majority of bladder cancer at presentation and high-grade lamina-invasive bladder cancer (HGLIbc) previously known as T1G3 is the most controversial subtype as far as treatment is concerned. Should the patient be given BCG or is an initial cystectomy a better outcome? If BCG is started should the patient be kept on maintenance? Urothelial cancer has no effective adjuvant treatment, therefore being proactive in identifying aggressive tumors to begin with would help in improving survival. This short review, based on the contemporary literature has tried to evolve an approach which may help in making clinical decision to treat HGLIbc.