Advancements in the Diagnosis, Treatment, and Risk Stratification of Non-Muscle Invasive Bladder Cancer

Purpose of ReviewThis review examines the evolving landscape of non-muscle invasive bladder cancer (NMIBC) management, focusing on risk stratification, novel therapeutic strategies, and the integration of biomarkers into clinical care.Recent FindingsEmerging genomic markers such as FGFR3 and TERT promoter mutations show promise for diagnosis and personalized treatment. Advances in immunotherapy, including the use of pembrolizumab and nadofaragene firadenovec, offer options for BCG-unresponsive NMIBC, though challenges like cost and adverse effects remain. Current guidelines emphasize stratified care based on risk, balancing treatment intensity with recurrence and progression risks.SummaryWhile transurethral resection with intravesical therapy remains the standard for most NMIBC, early radical cystectomy is pivotal for select high-risk cases. Future directions highlight the need for biomarker-driven models to refine treatment paradigms, reduce overtreatment, and improve long-term outcomes. Continued clinical trials are essential to validate these approaches and address unmet needs in NMIBC care.