Management of pT1G3 Bladder Cancer

ContextGuidelines for the management of pT1G3 bladder cancer (BCa) are based on different and specific levels of evidence.ObjectiveThis review examines the clinical evidence for the management of pT1G3 BCa with an organ-preserving approach and with radical cystectomy (RC) and the risk factors involved.Evidence acquisitionData were acquired from the recent literature.Evidence synthesisThe tumour biology and outcome of T1G3 bladder tumours is variable. Organ preservation is feasible in solitary tumours, with few risk factors after a second transurethral resection of bladder tumour and no evidence of residual disease. Other patients should be offered RC unless they are not fit to undergo major surgery. Risk factors include concomitant carcinoma in situ, tumour multifocality, tumour diameter >3 cm, and depth of lamina propria infiltration.ConclusionsTreatment outcome may be improved through risk stratification and patient selection. In patients fit for major surgery showing multiple risk factors and at high risk for progression, RC with extended pelvic lymph node dissection should be offered. In patients with solitary tumours presenting with few risk factors and in patients not fit for major surgery, a conservative organ-preserving approach is acceptable. This risk constellation must be kept in mind for adequate counselling of patients with T1G3 disease in our everyday practice.