Is radical cystectomy an overtreatment for T1 high-grade transitional cell carcinoma of the bladder? Lesson learnt from case series

The introduction of intravesical bacillus Calmette-Guerin (BCG) made a breakthrough in the treatment of high-grade nonmuscle-invasive bladder cancer. Indeed, the intravesical immunotherapy helped many patients in preserving their bladder for a period of time. However, many studies revealed that <50% of the patient will be able to maintain their bladder in 5 years of follow-up. The shortage of BCG adds to the odds of cancer progression and patient suffering. We present a series of three cases of disease progression despite the confirmed pathologic local staging of the bladder cancer to be nonmuscle disease. The message we would like to address from this review is that radical cystectomy is not an overtreatment of this potentially lethal disease.