Recurrent Ta Low-grade Non-muscle-invasive Bladder Cancer: What Are the Options?

Recurrent low-grade Ta tumours, classified as intermediate-risk non-muscle-invasive bladder cancer (NMIBC), have a high risk of recurrence but a low risk of progression. This case presents a 60-yr-old female with intermediate-risk NMIBC who has been treated with sequential courses of mitomycin C followed by bacillus Calmette-Guérin (BCG). She continued to develop multiple episodes of recurrence. The discussion addresses whether the best course is repeat transurethral resection of the bladder with continued monitoring, more of the same intravesical treatments, new methods of applying these treatments, or novel treatments that might involve enrolling the patient in a clinical trial. The biggest unmet need in the field comes from the lack of a molecular marker that could help select patients for aggressive strategies. PATIENT SUMMARY: Following treatment of intermediate-risk non-muscle-invasive bladder cancer with a fairly standard course of intravesical drug therapy, the patient, a relatively young woman, continued to develop recurrences of the bladder cancer. The authors discuss whether the best next course is "more of the same", device-assisted application of these treatments, or perhaps one of the new, still investigatory treatment approaches. Radical surgery (removal of the bladder) should not be necessary unless the recurrences show signs of disease progression.