Carcinoma in Situ of the Bladder: Why Is It Underdetected?

José D. Subiela; Óscar Rodr&ıacute; guez Faba; Félix Guerrero-Ramos; Julia Aumatell; Alberto Breda; Joan Palou


Curr Opin Urol. 2020;30(3):392-399. 

In This Article


Based on current data, there is no doubt that the use of the new optical technology significantly increases the rate of CIS detection, allowing early detection and apparently impacting on the oncological outcome. Nevertheless, its use in daily practice has not yet been standardized. The benefit of using the MRI-PDD pathway is still unclear, and further studies are necessary. The first-line treatment of CIS remains instillation with BCG, which has been shown to reduce recurrence and progression, especially with the use of maintenance. It appears that intravesical device-assisted therapies (EMDA and RF-CHT) could be effective in both BCG-naïve and BCG-unresponsive selected CIS patients, but further studies are ongoing to confirm their oncological benefit. The results of KEYNOTE-057 trial are promising, and numerous RCTs combining BCG with immune checkpoint inhibitors for high-risk BCG-naïve and BCG-unresponsive NMIBC are ongoing to evaluate its efficacy and potential role in reducing the need for radical cystectomy.