From the Guidelines
The best treatment for T1 (tumor invades the lamina propria) bladder cancer is intravesical BCG therapy or cystectomy.
Treatment Options
- Intravesical BCG therapy: This is the preferred treatment option for high-grade T1 tumors, as it has been shown to decrease the risk of bladder cancer recurrence following TURBT 1.
- Cystectomy: This is recommended for patients with high-risk T1 tumors, especially if residual disease is found after repeat TURBT, due to the high risk of progression to a more advanced stage 1.
Treatment Approach
- TURBT: A complete endoscopic resection is recommended for T1 tumors, followed by a repeat TURBT if necessary to ensure complete removal of the tumor 1.
- Intravesical therapy: BCG is the preferred intravesical agent for high-grade T1 tumors, with mitomycin C being an alternative option 1.
- Maintenance therapy: Maintenance BCG is recommended for patients who received prior BCG, to reduce the risk of recurrence and progression 1.
High-Risk T1 Tumors
- Multifocal lesions: These tumors are considered high-risk and may require early cystectomy due to the high risk of progression 1.
- Tumors associated with carcinoma in situ or lymphovascular invasion: These tumors are also considered high-risk and may require early cystectomy 1.
From the Research
Treatment Options for T1 Bladder Cancer
The treatment for T1 bladder cancer, which invades the lamina propria, can vary depending on several factors, including the grade of the tumor and the patient's overall health.
- Treatment with bacillus Calmette-Guérin (BCG) is a common approach for high-grade T1 bladder cancer, as it allows for bladder preservation but may risk disease progression 2, 3, 4, 5.
- Radical cystectomy, or the removal of the bladder, is considered the best chance at cure for high-grade T1 bladder cancer, but it is a major surgery with a high risk of morbidity and is overtreatment for some patients 2, 3, 6, 5.
- A risk-stratified approach is recommended to select patients for immediate radical cystectomy, taking into account factors such as tumor size, multifocality, and presence of variant histology or lymphovascular invasion 3, 5.
- A second re-TUR (transurethral resection) is recommended for cases with T1 high-grade bladder cancer to ensure accurate staging and to remove any remaining tumor tissue 2, 3, 5.
Bladder Preservation Approach
For patients who elect a bladder preservation approach,
- Induction BCG therapy followed by a maintenance schedule is recommended 2, 3, 4, 5.
- Immediate postoperative instillation of chemotherapy can decrease the risk of recurrence in patients with stage Ta T1 bladder cancer 4.
- Intravesical BCG appears to be the treatment of choice for the management of carcinoma in situ and is superior to Mitomycin C in reducing tumor recurrence in high-risk nonmuscle-invasive bladder cancer 4.
Radical Cystectomy
For patients with high-risk features, such as hydronephrosis, abnormal bimanual examination, variant histology, lymphovascular invasion, or residual disease on re-resection,
- Immediate radical cystectomy is recommended as it provides an improved opportunity for cure compared to a bladder-preserving strategy 3, 6, 5.
- Patients who undergo delayed cystectomy after recurrence have a poorer prognosis, with an estimated 5-year disease-specific survival of only 24% and a median survival of 35 months 6.