This protocol covers non-muscle-invasive bladder cancer (NMIBC) in the intermediate-risk group — without concurrent carcinoma in situ and not meeting criteria for low-risk, high-risk, or very high-risk classification — when the initial treatment line did not achieve the primary recurrence goal.
Intermediate-risk NMIBC comprises patients without CIS who are not included in either the low-, high-, or very high-risk groups. Precise risk-group assignment guides the choice and duration of intravesical treatment.
Initial management consisted of transurethral resection of bladder tumour (TURBT) followed by intravesical chemotherapy induction, with or without maintenance up to one year; or alternatively, a one-year full-dose intravesical BCG course. This protocol is indicated when the central goal of the first line — no bladder tumour recurrence on cystoscopy at 3 months — was not met.
When recurrence occurs during or after an intravesical chemotherapy regimen, intravesical BCG immunotherapy is the established next step. The complete instillation schedule — including induction course length and maintenance intervals — is set out in full in the structured protocol below.
Success is defined as no high-grade bladder tumour recurrence on cystoscopy at 3 months and negative urine cytology for high-grade urothelial carcinoma. The 3-month cystoscopy after TURBT is a key prognostic landmark for both recurrence and progression.