Management Dilemma for Very High-risk Non-muscle-invasive Bladder Cancer: Real-World Data Challenge the Guideline Recommendation for Upfront Radical Cystectomy.

Subiela, José Daniel; Scilipoti, Pietro; Contieri, Roberto; Lobo, Nijati; Pichler, Renate; Kamat, Ashish M · Eur Urol · 2025

review · Level V

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Abstract

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.

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