The cost of intensification in high-risk non–muscle-invasive bladder cancer

Non–muscle-invasive bladder cancer (NMIBC) is a common and costly disease that requires experienced teams and adequate infrastructure for its management. Although characterized by high rates of recurrence, a subset of patients also faces a substantial risk of progression to muscle-invasive or metastatic disease, making appropriate risk-adapted treatment essential. Intravesical bacillus Calmette–Guérin (BCG) remains a mainstay of treatment. However, recurrent BCG shortages and the clinical challenge of BCG-unresponsive disease have fueled interest in alternative and treatment-intensification strategies.