Witjes - Figure 60

Cystectomy in high-risk NMIBC

FIG. 60:  The advice in BCG failures in high-risk patients or very high-risk patients is to perform upfront cystectomy, and of course this is associated with very good survival.  Cancer-specific survival is in the range of 90%, because although patients will still die of cancer, if the surgery is done well, quality of life will be comparable to that of the general population.  However, if upfront cystectomy were performed in all high-risk patients, it would be overtreatment in a significant percentage of patients.  Even in experienced hands, it is major surgery with morbidity and with mortality, and obviously for cosmesis it is not the best option.