Acknowledging the advances in bladder cancer. Focused on closing the gap

Bladder cancer is the 6th most common form of cancer in the US, and 75% of the 84,870 new bladder cancer cases are NMIBC.1,2 While the last several years have brought advancements in bladder cancer treatment, NMIBC continues to present with high recurrence and progression risks.3–5 There remains a significant opportunity to improve how we assess and care for our patients.

Bladder cancer staging: distribution of newly diagnosed patients4

Inset image of a bladder, illustrating the stage at which bladder cancer patients are usually diagnosed Inset image of a bladder, illustrating the stage at which bladder cancer patients are usually diagnosed

NMIBC prevalence in the US

Chart showing 75% non-muscle-invasive bladder cancer prevalence in the US Chart showing NMIBC risk stratification, ~30% low, ~30% intermediate, and ~40% high
*The NMIBC population comprises low-, intermediate-, and high-risk patients; proportions are not shown to scale.

Diagnoses across NMIBC are characterized by high rates of recurrence and progression:

  • Patients with newly diagnosed high-risk NMIBC have a 60%-70% chance of recurrence3,4
  • 10%-45% chance of progression to muscle-invasive or metastatic bladder cancer within 5 years
  • Intermediate-risk disease has a 38% recurrence rate at 3 years and 50% recurrence rate at 5 years5
  • Low-risk disease has a recurrence rate of 50% within 4 years6
Identifying risk is critical for providing individualized care plans and setting patients’ expectations
Determining NMIBC risk stratification using AUA framework
The recurrence rate for NMIBC varies depending on the patient’s AUA/SUO risk stratification for recurrence and progression.2

AUA Risk Stratification for NMIBC4

Table depicting AUA risk stratification for non-muscle-invasive bladder cancer

Low-risk

LGa solitary Ta ≤3 cm
PUNLMPb
Table depicting AUA risk stratification for non-muscle-invasive bladder cancer

Intermediate-risk

Recurrence within 1 year, LG Ta
Solitary LG Ta >3 cm
LG Ta, multifocal
HGc Ta, ≤3 cm
LG T1
Table depicting AUA risk stratification for non-muscle-invasive bladder cancer

High-risk

HG T1
Any recurrent, HG Ta
HG Ta, >3 cm (or multifocal)
Any CISd
Any BCG failure in HG patient
Any variant histology
Any LVIe
Any HG prostatic urethral involvement
aLG=low grade; bPUNLMP=papillary urothelial neoplasm of low malignant potential; cHG=high grade; dCIS=carcinoma in situ; eLVI=lymphovascular invasion.
AUA=American Urological Association; SUO=Society of Urologic Oncology.
Accurate assessment of patient risk is the foundation of modern NMIBC management, enabling providers to personalize care, optimize treatment options, and align patients with the right therapy at the right time.2
Watch Dr Gary Steinberg as he explains risk stratification levels in NMIBC
Thumbnail for video featuring urologist Gary Steinberg who explains risk stratification levels in NMIBC
A bladder cancer patient, holding a glass of water, contemplates treatment burden Not an actual patient.

NMIBC surveillance and treatment often carry heavy burdens for patients

The burdens of the NMIBC surveillance schedule include:

  • Periodic invasive monitoring with cystoscopy: over 50% of patients with bladder cancer report moderate-to-severe discomfort during cystoscopy7
  • Impact on quality of life and activities of daily living8–10
  • Medical costs adding to financial challenges11
  • Increasing concerns as the disease progresses11,12
Improving both the emotional and physical experiences of patients with NMIBC remains an important area of focus13

Adverse events and complications associated with long-standing treatment options may compromise efficacy, durability, tolerability, and safety13:

Icon depicting transurethral resection of bladder cancer tumor (TURBT)

TURBT (Transurethral Resection of Bladder Tumor): although it remains the cornerstone of NMIBC staging and treatment, TURBT commonly causes bleeding, pain, and burning while urinating, sometimes even weeks after the procedure.14,15 In some cases, a catheter may need to be placed in a patient’s bladder to facilitate healing or manage bleeding, which can cause pain or discomfort, blood in the urine, or a sense of urinary urgency.15,16 While the rate of repeat TURBT varies, up to 43% of patients will require more than 1 TURBT.17

How long can I keep doing this? Can I do this for another 20 years? I really don’t know. It doesn’t get easier. You worry about what they’ll find this time. If this is the one that pushes you into needing your bladder removed.

– Repeat TURBT patient18
Icon depicting Bacillus Calmette-Guérin (BCG) treatment for bladder cancer

BCG treatment: associated with high rates of adverse events/effects and poor tolerability, which can result in treatment discontinuation.13,19 Because side effects are so common, many patients believe that shouldering the symptoms are a necessary burden for the therapy’s ability to work.20

The more I suffered, the more I thought, ‘it’s working.’ It’s weird, isn’t it? The worse I was, the more I thought it was working.

– Female patient, 60 years old20
Icon depicting radical cystectomy for bladder cancer

Radical cystectomy (RC): associated with high rates of peri- and post-operative complications and post- operative mortality.21,22 Patients who undergo RC often experience problems with body image, sexual intimacy, and sexual enjoyment following surgery.23 While it’s the only potentially curative treatment for high-risk BCG- unresponsive NMIBC, patients often assess their situation about 3 years after surgery and find this loss of sense of self outweighs all aspects of quality of life.24

I don’t have friends. No more sex life. I feel destroyed: physically, emotionally. Once I was master of myself; now I depend on my wife. The surgery carried away all that I had.

– Male RC patient, 81 years old, 3 years after RC24
While multiple FDA-approved NMIBC therapies have recently become available, an unmet need remains that considers durability of response and tolerability in an approach that respects the complete patient experience25-28
References: 1. National Cancer Institute website. Accessed January 15, 2026. http://cancer.gov 2. Holzbeierlein JM, Bixler BR, Buckley DI, et al. Diagnosis and treatment of non-muscle invasive bladder cancer: AUA/SUO guideline: 2024 amendment. J Urol. 2024;211:533-538. 3. Sylvester RJ, van der Meijden APM, Oosterlinck W, et al. Predicting recurrence and progression in individual patients with stage Ta T1 bladder cancer using EORTC risk tables: a combined analysis of 2596 patients from seven EORTC trials. Eur Urol. 2006;49:466-477. 4. Holzbeierlein J, Bixler BR, Buckley DI, et al. Diagnosis and treatment of non-muscle invasive bladder cancer: AUA/SUO guideline: 2024 amendment. J Urol. 2024. 5. Soria F, Rosazza M, Livoti S, et al. Clinical validation of the intermediate-risk non-muscle-invasive bladder cancer scoring system and substratification model proposed by the International Bladder Cancer Group: a multicenter Young Academic Urologists Urothelial Working Group collaboration. Eur Urol Oncol. 2024;7:1497-1503. 6. Ma J, Roumiguie M, Hayashi T, et al. Long-term recurrence rates of low-risk non-muscle-invasive bladder cancer—how long is cystoscopic surveillance necessary? Eur Urol. 2024;10:189-196. 7. Kukreja JB, Schroeck FR, Lotan Y, et al. Discomfort and relieving factors among patients with bladder cancer undergoing office-based cystoscopy. Urol Oncol. 2022;40:9e19-9e27. 8. Brisbane WG, Holt SK, Winters BR, et al. Nonmuscle invasive bladder cancer influences physical health related quality of life and urinary incontinence. Urology. 2019;125:146-153. 9. Cox E, Saramago P, Kelly J, et al. Effects of bladder cancer on UK healthcare costs and patient health-related quality of life: evidence from the BOXIT trial. Clin Genitourinary Cancer. 2019;18(4):e418-e442. 10. Nayak A, Cresswell J, Mariappan P. Quality of life in patients undergoing surveillance for non-muscle invasive bladder cancer—a systematic review. Transl Androl Urol. 2021;10(6):2737-2749. 11. Casilla-Lennon MM, Choi SK, Deal AM, et al. Financial toxicity in bladder cancer patients—reasons for delay in care and effect on quality of life. J Urol. 2018;199(5):1166-1173. 12. Koo K, Zubkoff L, Sirovich BE, et al. The burden of cystoscopic bladder cancer surveillance: anxiety, discomfort, and patient preferences for decision making. Urology. 2017;108:122-128. 13. Griebsch I, Shrestha S, Lotan Y, et al. The impact of intravesical instillations on quality of life in patients with non-muscle-invasive bladder cancer: a systematic review. Oncol Ther. 2025;13:895-918. 14. Fink B, Son Y, Mueller T, et al. The role of TURBT in bladder cancer: standardizing surgical approaches and future directions to improve patient outcomes. Reviews in Urol. 2025;24:1-9. 15. Strother M, Barlotta R, Uzzo R, et al. Symptomatic and functional recovery after transurethral resection of bladder tumor: data from ecological momentary symptom assessment. Urol Oncol. 2024;42:117.e1-117.e10. 16. Saint S, Trautner BW, Fowler KE. A multicenter study of patient-reported infectious and noninfectious complications associated with indwelling urethral catheters. JAMA Intern Med. 2018;178(8):1078-1085. 17. Grabe-Heyne K, Henne C, Mariappan P, et al. Intermediate and high-risk non-muscle-invasive bladder cancer: an overview of epidemiology, burden, and unmet needs. Front Oncol. 2023;13:1-17. 18. Parisse T, Reines K, Basak R, et al. Patient and provider perception of transurethral resection of bladder tumor vs chemoablation for non-muscle-invasive bladder cancer treatment. J Urol. 2023;209:150-160. 19. Nummi A, Jarvinen R, Sairanen J, et al. A retrospective study on tolerability and complications of bacillus Calmette-Guérin (BCG) instillations for non-muscle-invasive bladder cancer. Scandinavian J Urol. 2019;53(2-3):116-122. 20. Alcorn J, Topping A. Withdrawing from treatment for bladder cancer: patient experiences of BCG installations. Int J Urol Nursing. 2020;(3)14:106-114. 21. Maibom SL, Røder MA, Poulsen AM, et al. Morbidity and days alive and out of hospital within 90 days following radical cystectomy for bladder cancer. Eur Urol. 2021;28:1-8. 22. Berger I, Leilei X, Wirtalla C, et al. 30-day readmission after radical cystectomy: identifying targets for improvement using the phases of surgical care. Can Urol Assoc J. 2019;13(7):E190-201. 23. Catto JWF, Downing A, Mason S, et al. Quality of life after bladder cancer: a cross-sectional survey of patient-reported outcomes. Eur Urol. 2021;79:621-632. 24. Cerruto MA, D’Elia C, Cacciamani G, et al. Behavioural profile and human adaptation of survivors after radical cystectomy and ileal conduit. Health Qual Life Outcomes. 2014;12:46. 25. Kamat A, Hafron J. Unmet needs in high-risk non-muscle-invasive bladder cancer from the patient’s perspective: challenges and potential solutions. Rev Urol. 2024;23(4):29-39. 26. Inlexzo. Prescribing Information. Janssen Biotech, Inc.; September 2025. 27. Zusduri. Prescribing Information. UroGen Pharma, Inc.; June 2025. 28. Anktiva. Prescribing Information. Altor BioScience, LLC; April 2024.
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