Bladder cancer is a lethal and prevalent cancer, with T1 disease accounting for 24 percent of new cases. Because of its clinical heterogeneity and established risks of recurrence, progression, and cancer-specific mortality, high-grade T1 is a very challenging entity to treat. The variations in guidelines from major urologic organizations highlight this heterogeneity, and another BCG scarcity occurred in the last year, confounding care even further. The molecular and genetic characterization of high-grade T1 has advanced, and new clinical studies to evaluate alternate therapeutics are now accessible. Researchers discussed the variances in recommendations, BCG alternatives, developing molecular and genomic findings, and current clinical studies for the review.

The heterogeneity in accessible recommendations contributed to low adherence to community-based guidelines for non-muscle-invasive bladder cancer among practicing urologists. Reduced dosage schedules and alternate intravesical solutions were increasingly adopted in the face of a BCG scarcity. New biomarkers were developed in order to better risk-stratify patients, with future medicines focusing on aggressive illness.

Although HGT1 urothelial carcinoma remains a very diverse and aggressive disease, great progress is made in better identifying the clinical and molecular variables that drive recurrence and progression in order to better guide treatment.