Current approaches for identifying high-risk non-muscle invasive bladder cancer.

INTRODUCTION: Management of high risk non-muscle invasive bladder cancer (NMIBC) is challenging. It is vital to detect recurrences early and predict which tumors are likely to progress. Areas covered: This manuscript reviews the current approaches available for detection and surveillance of high risk NMIBCs. A literature review was utilized to evaluate risk factors for recurrence and progression as well as evaluating approaches including pathological aspects of NMIBC, molecular subtyping, methods for tumor visualization, urine cytology, urinary molecular markers, molecular tissue markers as well as the scoring systems and nomograms. Expert commentary: Clinical and pathological factors are still the mainstay of prediction of recurrence and progression. However, genomic information such as molecular subtyping may improve understanding of prognosis. White light cystoscopy is still a dominant approach but enhanced cystoscopy is likely superior for detection of cancer especially carcinoma in situ. Urinary biomarkers are evolving; however, they are not ready to replace cystoscopy and trials are still necessary to determine optimal clinical utility. Prognostic scoring systems and nomograms are available for counseling the patients but there is room to improve predictive accuracy.