Case 2026: Frank (expert opinion by B. Szabados)

Frank, currently 74 years old, lives near the Museumplein and enjoys sitting on a bench overlooking the open square. On sunny days, he often watches children playing and tourists taking photos beside the famous landmarks.

He was diagnosed with high-risk NMIBC.

Initial assessment:

• Primary T1 high-grade; pure urothelial carcinoma
• Re-TURBT negative for residual disease
• No concomitant CIS

Treatment with intravesical BCG was started:

• 6/6 induction instillations
• 3/3 maintenance instillations (1st course)
• 3/3 maintenance instillations (2nd course)

At the 9-month surveillance cystoscopy, a new papillary lesion is identified.

Current assessment:

• ECOG PS: 0
• Urine cytology: suspicious for HG UCa (according to the Paris system)
• Conventional TURBT: resection visually complete, pathological review:
  • pTa high-grade; pure urothelial carcinoma
  • No concomitant CIS
  • No LVI
  • Muscularis propria in specimen, uninvolved
• CT urography: cN0, no concomitant upper tract tumour

The patient received adequate counselling, and refuses RC.