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Light microscopy of the internal lining of the urinary bladder; haematoxylin and eosin stain
Managing High-Risk NMIBC

Smart risk tools to personalize NMIBC care

Last updated: 13th Oct 2025
Published: 1st Sep 2025

After listening to this podcast, are you more confident in using risk stratification tools to personalize care for patients with NMIBC?

Episode 3. BCG, cystectomy, or other bladder-sparing treatment options? Ashish Kamat and Félix Guerrero-Ramos discuss how guideline-based risk stratification (EAU, IBCG) meets the realities of clinical practice. From intermediate-risk dilemmas to the nuances of BCG treatment duration and unresponsive disease, they explore how clinical choices shift when patient profiles and preferences enter the equation. Ramos shares his guiding principle: “You need to tailor the therapy to the patient, not just to the tumor.” Plus, he shares the one red flag that could change everything. View transcript.

Chapters
00:00 Welcome and introductions
00:39 Why stratify NMIBC patients?
03:32 Explaining treatment to patients
04:51 Treatment by risk category
06:00 Who needs cystectomy vs BCG?
10:08 Are molecular tools used today?
12:17 What defines BCG-unresponsive?
18:05 What if BCG no longer works?
19:55 What’s next for stratification?
21:13 Wrap-up

 

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Meet the guest speaker

Dr. Félix Guerrero-Ramos, circle photo, profile pictureFélix Guerrero-Ramos, MD, PhD, FEBU

Félix Guerrero-Ramos is an attending urologist at Hospital Universitario 12 de Octubre in Madrid, Spain, where he coordinates the Urological Oncology section. He specializes in surgeries within urological oncology and has been the principal investigator for over 30 phase 1–4 clinical trials on bladder and renal cancer. He also collaborates as a Professor and Academic Tutor for final-year medical students at the Faculty of Medicine, Universidad Complutense de Madrid.

Disclosures: Research support / Principal Investigator for Astellas, AstraZeneca, Bristol Myers Squibb, Cepheid, Combat Medical, enGene, Fidia, Johnson & Johnson, MSD, Pfizer, Roche, Seagen, Taris, and UroGen. An employee of SERMAS (Servicio Madrileño de Salud). Consultant services for AstraZeneca, Bristol Myers Squibb, Combat Medical, enGene, Johnson & Johnson, Merck, MSD, Nanobots Therapeutics, Pfizer, Roche, and Taris. Stockholder in CG Oncology, Johnson & Johnson, and Pfizer. Speaker bureau for AstraZeneca, Bristol Myers Squibb, Combat Medical, Janssen, Johnson & Johnson, Merck, MSD, Nucleix, Pfizer, Palex, and Recordati. Travel support for Alter, AstraZeneca, Combat Medical, Fidia, Ipsen, Johnson & Johnson, Nucleix, Pfizer, Recordati, and Salvat. Member of scientific advisory boards for AstraZeneca, Bristol Myers Squibb, Combat Medical, enGene, Johnson & Johnson, MSD, Nucleix, Pfizer, Roche, and Taris. Manuscript support from AstraZeneca, Bristol Myers Squibb, Combat Medical, Janssen, Johnson & Johnson, and Pfizer.

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