We discuss real-world evidence that challenges the guideline recommendation of upfront radical cystectomy for all patients with very high-risk non-muscle-invasive bladder cancer. The evidence highlights the need for more accurate and dynamic tools to guide clinical decision-making. Until these are available, treatment decisions should be individualized and made in close consultation with the patient.
European urology. 2025 May 14 [Epub ahead of print]
José Daniel Subiela, Pietro Scilipoti, Roberto Contieri, Nijati Lobo, Renate Pichler, Ashish M Kamat
Department of Urology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Universidad de Alcala, Madrid, Spain. Electronic address: ., Division of Experimental Oncology, Department of Urology, Urological Research Institute, Vita-Salute San Raffaele University, Milan, Italy., Department of Urology, Istituto Nazionale Tumori di Napoli IRCCS, Fondazione G. Pascale, Naples, Italy., Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA., Department of Urology, Comprehensive Cancer Center Innsbruck, Medical University of Innsbruck, Innsbruck, Austria.