Non-muscle invasive bladder cancer (NMIBC) accounts for over 75% of bladder cancer cases worldwide and is associated with high recurrence rates and significant surveillance costs. Advances in diagnostic modalities, risk stratification, and bladder-preserving therapies have transformed management strategies.
This narrative review synthesizes evidence from 70 key publications identified through a comprehensive search of PubMed, MEDLINE, Embase, Scopus, and Google Scholar (2005-2025). Topics include clinical presentation, diagnostic innovations such as enhanced cystoscopy and urinary biomarkers, contemporary risk stratification models, and evolving treatment paradigms including intravesical therapy, immunotherapy, and gene therapy.
NMIBC management is shifting toward precision-based, multimodal approaches that integrate molecular biomarkers, immunotherapy, and novel drug delivery systems. While early-phase trials show promise, large-scale studies and real-world data are essential to validate these strategies. Personalized surveillance using circulating and urinary tumor DNA may reduce procedural burden and improve outcomes, marking a paradigm shift toward adaptive, patient-centered care.
Over three-quarters of bladder cancers present as non-muscle invasive bladder cancer (NMIBC), a disease characterized by frequent recurrences and substantial long-term surveillance costs.Advances in diagnostic tools, particularly blue light cystoscopy and evolving urinary biomarker assays, enhance detection accuracy and lower recurrence rates compared with conventional white-light cystoscopy.Updated risk classification systems (AUA/SUO, EAU, and AI-driven models such as PROGRxN-BCa) are improving estimation of recurrence and progression risk, enabling more individualized care.Intravesical treatment remains central to NMIBC management, with BCG continuing as the primary therapy for high-risk disease; during BCG shortages, sequential chemotherapy and novel heat-based delivery systems serve as alternatives.Emerging bladder-preserving therapies, including checkpoint inhibitors, gene-based therapeutics, and controlled-release intravesical platforms, demonstrate encouraging activity in patients with BCG-unresponsive disease.Novel molecular surveillance approaches (ctDNA, utDNA, and urine-derived biomarkers) are poised to shift follow-up toward adaptive, biomarker-guided protocols, potentially reducing procedural burden and improving patient-centered outcomes.
Future science OA. 2026 Feb 09 [Epub]
Sri Saran Manivasagam, Amar Kassim, Jay D Raman
Department of Urology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA., Pennsylvania State University College of Medicine, Hershey, PA, USA.