Prophylaxis of recurrence in low-to-intermediate risk non-muscle invasive bladder cancer (NMIBC)

Background Low- and intermediate-risk non-muscle invasive bladder cancer (NMIBC) is characterized by a relatively high risk of recurrence and adjuvant instillation therapy is considered standard of treatment for the majority of patients. Objectives To provide a current and in-depth review on the role of adjuvant therapy in low-to-intermediate risk NMIBC. Methods A PubMed-based search focusing on specific keywords (BCG, EORTC, early instillation, intermediate-risk, low-risk, mitomycin, NMIBC, recurrence) was conducted to identify studies published between 2000 and 2021. The corresponding publications were assessed based on their clinical relevance to the question at hand and their pro/retrospective approach. Results The EORTC risk tables are most frequently used to determine the risk of recurrence. In low-risk NMIBC, transurethral bladder tumor resection (TURBT) followed by early instillation is considered standard of treatment. In intermediate-risk NMIBC, TUR-BT is followed by adjuvant instillations with either chemoinstillation or BCG. Conclusions Consequent use of adjuvant instillation therapy is necessary to reduce the risk of recurrence. New agents and modes of drug delivery (i.e. chemoablation) on the horizon have the potential to further improve outcomes.