Surveillance in intermediate bladder cancer

Episode 7. “I think it makes sense to differentiate between the lower-risk intermediate group and the higher-risk intermediate group, because treatment and follow-up will differ substantially between those two ends of the intermediate-risk spectrum,” says Fred Witjes. Together with Ashish Kamat, he explores how shifting guideline definitions are reshaping the identification and treatment approaches for patients in this clinical “gray zone” of intermediate-risk NMIBC. They unpack how recurrence history and tumor multiplicity influence risk stratification, and share practical strategies for tailoring management through options like intravesical therapy, active surveillance, and urinary markers. For patients where cystoscopy may be challenging or undesirable, they also consider how urinary markers and other non-invasive approaches could help clinicians monitor disease without compromising care. View transcript.

Chapters
00:00 Welcome and introductions
00:36 Defining intermediate-risk NMIBC
03:05 Optimizing NMIBC treatment
05:47 Surveillance and follow-up tools
08:50 Markers, imaging, and MRI in NMIBC
12:45 Tailoring treatment in NMIBC
16:41 Ablative therapy considerations
19:07 Intermediate NMIBC: Predictive tools
21:00 Wrap-up

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Meet the guest speaker

Fred Witjes, MD, PhD

Fred Witjes is a Professor of Oncological Urology at Radboud University Medical Center, Nijmegen, Netherlands. He specializes in cancers of the bladder, prostate, kidney, and testicle, and leads research integrating clinical diagnostics with surgical, immunotherapeutic, and chemotherapeutic approaches.

Disclosures: Advisor and lecturer for CAPS, Combat, JeMedis, Thermosome, (2024); Medac, Photocure (2025).