Case 2025: Fernando (expert opinion by E. Xylinas)

Fernando, 71 years old, is a bookstore owner from Coimbra. He spends most of his time surrounded by shelves of poetry, philosophy, and Portuguese classics. His small shop near the university is more than a business - it is a gathering place for students, writers, and old friends who come as much for conversation as for books.

He was diagnosed with intermediate-risk NMIBC 4.5 years ago, which was treated with TURBT followed by intravesical chemotherapy for 1 year. 
Follow-up cystoscopy 3 years after the final course of intravesical chemotherapy shows multiple reddish lesions at the anterior bladder wall.
Assessment summary:

• No relevant medical history
• ECOG PS: 0
• Urine cytology: HG UCa (according to the Paris system)

On TURBT urothelial CIS was detected. A CT urography ruled out nodal and upper tract involvement.

BCG induction was started and followed by maintenance BCG. CIS is present 3 months after the start of BCG (i.e. BCG induction completed) and persists at 6 months (i.e. first course of maintenance completed).