This protocol covers male patients diagnosed with non-muscle-invasive bladder cancer (NMIBC) where carcinoma in situ (CIS) is found in the epithelial lining of the prostatic urethra — a presentation exclusive to male anatomy that carries distinct management implications.
All patients with CIS in the prostatic urethra should be included in the very high-risk group. This risk classification directly shapes the choice between a bladder-sparing strategy and more definitive surgical management.
Improving contact of intravesical therapy with the prostatic urethra is a specific procedural consideration in this setting.
When a bladder-sparing strategy is considered, a surgical procedure on the prostate may be performed to facilitate intravesical BCG instillation therapy. Radical cystectomy is an alternative when bladder preservation is not appropriate.
All patients with CIS in the prostatic urethra, with certain subtypes of UC, or with LVI, should be included in the very high-risk group.
Patients with CIS in the epithelial lining of the prostatic urethra can be treated by intravesical instillation of BCG.
Transurethral resection or laser enucleation of the prostate can improve contact of BCG with the prostatic urethra.
Offer transurethral resection of the prostate, followed by intravesical instillation of BCG, to patients with CIS in the epithelial lining of the prostatic urethra, if a bladder sparing strategy is considered.
The first cystoscopy after TURBT at three months is an important prognostic indicator for recurrence and progression.
If CIS (without concomitant papillary tumour) is present at three months and persists at six months after either re-induction or first course of maintenance.