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Answer 2
  1. Repeat TURBT followed by intravesical bCG therapy. Although this patient has superficial bladder cancer, he also has high-risk features, including associated high-grade carcinoma in situ and vascular invasion, which increases his chance of relapse after TURBT alone.4 When administered with TURBT, intravesical therapy has been shown to increase 10-year progression-free survival and disease-specific survival by 25%, with a 5-year survival rate similar to that achieved with immediate radical cystectomy; these results support use of TURBT and bCG rather than cystectomy as initial therapy for these patients.5,6 TURBT alone has been reported to be sufficient for carefully selected patients without high-risk features and in the absence of a palpable mass or hydronephrosis. Radiotherapy does not reduce or delay progression or death from superficial bladder cancer.7

    4. Herr HW. Tumor progression and survival in patients with T1G3 bladder tumors: 15-year outcome. Br J Urol 1997;80:762-5.

    5. Herr HW, Schwalb DM, Zhang ZF, et al. Intravesical bacillus Calmette-Guérin therapy prevents tumor progression and death from superficial bladder cancer: ten-year follow-up of a prospective randomized trial. J Clin Oncol 1995;13:1404-8.

    6. Brake M, Loertzer H, Horsch R, Keller H. Long-term results of intravesical bacillus Calmette-Guérin therapy for stage T1 superficial bladder cancer. Urology 2000;55:673-8.

    7. Harland SJ; UK NCRI Bladder Clinical Studies Group. A randomised trial of radical radiotherapy in pT1G3 NXM0 bladder cancer (MRC BS06) [abstract]. J Clin Oncol 2005;23(16 Suppl):4505a.

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