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Bladder Cancer — SCE Medical Oncology MCQ

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HardUrological CancersBladder CancerSCE Medical Oncology

A patient has persistent high-grade T1 bladder cancer after induction BCG. Re-staging excludes muscle invasion. The patient understands the oncological advantage of cystectomy but declines it. What next step follows NICE NG2?

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Correct answer: A — Specialist urology MDT review for further intravesical therapy

NG2 requires specialist urology MDT review when induction BCG fails. The MDT assesses radical cystectomy, or further intravesical treatment when cystectomy is unsuitable or declined. Pembrolizumab has trial and non-UK regulatory evidence in this setting but is not the NICE NG2 recommendation. Automatic repeat BCG, surveillance alone and metastatic-style chemotherapy bypass the required risk-based MDT decision.

Reference: NICE NG2 bladder cancer recommendations (Current NICE guidance, accessed August 2026): https://www.nice.org.uk/guidance/ng2/chapter/Recommendations