72 year old woman who had one episode of gross hematuria and saw a urologist for an investigation.
Her general health is good. The only prior surgery was a cholecystectomy.
She smoked cigarettes for 15 years – one pack/day. She stopped 30 years ago.
She had a CT scan which was negative with the exception of a possible bladder tumor.
In October 2015 she underwent a TUR BT of a 3 cm solitary exophytic appearing tumor. The pathology was high grade (grade 3) Ta urothelial carcinoma of the bladder with an adjacent area of CIS. There was some concern that all tumor was not removed but this is not clear.
A decision was made to proceed with intravesical BCG. She received six weeks and tolerated all treatments.
She sought a second opinion in 1/2016 and an office cystoscopy identified a small area of erythema and a new or previously unresected exophytic appearing tumor. A TUR BT revealed CIS and focal HG T1a urothelial cancer of the bladder.
She underwent a reTUR BT and the prior resection site was identified an resected. It was no more than 1.5 cm in size. The rest of the bladder was normal in appearance. The pathology revealed HG Ta and focal CIS.
What would you suggest?