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Radical cystectomy in selected patients with extensive or refractory superficial tumors
Source: Bladder Cancer Treatment (PDQ®)–Health Professional Version, National Cancer Institute.
Source updated: May 2, 2025 · Captured 2026-09-09.
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Context: Treatment of Stage I Bladder Cancer / Treatment Options for Stage I Bladder Cancer
Radical cystectomy is used in selected patients with extensive or refractory superficial tumors.[35-43] Patients at high risk of progression, typically those with recurrent high-grade tumors with carcinoma in situ after intravesical therapy with BCG, should consider radical cystectomy. Other risk factors include multiple tumors and tumors larger than 3 cm.
Certain patients with nonmuscle-invasive bladder cancer face a substantial risk of progression and death from their cancers.
Evidence (radical cystectomy):
One analysis of 307 patients enrolled in studies of intravesical BCG in the 1980s reported that among 85 patients with T1 recurrence, 60 progressed to at least stage II disease. Five years after T1 recurrence, 71% had progressed and 48% had died of their cancer.[44]
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By comparison, in another cohort of 589 patients treated with BCG between 1992 and 2004, 65 of the 120 patients with T1 recurrence underwent immediate cystectomy. Among all patients with T1 recurrence, 28% progressed to more-advanced–stage disease and 31% died of their cancer. While these data confirm that patients with recurring cancer after intravesical BCG face a substantial risk of dying of their disease, they do not provide strong evidence that immediate cystectomy results in a lower risk of death or progression.[44]
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Preserved source evidence · Not medical advice