Urology: non-muscle-invasive bladder cancer: practice question

A General Surgery question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Surgery · Urology: non-muscle-invasive bladder cancer

Sample item

A 66-year-old man has a complete transurethral resection of a high-grade pTa urothelial carcinoma with carcinoma in situ. The specimen contains detrusor muscle without invasion, and staging scans are clear. Which adjuvant therapy reduces recurrence and progression?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Intravesical BCG

High-grade non-muscle-invasive bladder cancer and carcinoma in situ carry a high risk of recurrence and progression. Intravesical BCG immunotherapy after complete resection reduces both and is the standard of care. Cystectomy is reserved for BCG failure, muscle invasion or very high-risk disease.

Option by option

  • A. Intravesical BCG (correct)

    Intravesical BCG induces a local immune response against residual tumour cells.

  • B. External beam radiotherapy to the pelvis

    Pelvic radiotherapy is not an established adjuvant for non-muscle-invasive bladder cancer.

  • C. Single-dose systemic cisplatin

    Systemic cisplatin is used with muscle-invasive disease, not in pTa and carcinoma in situ.

  • D. Immediate radical cystectomy

    Cystectomy is excessive for non-invasive disease that can be managed with BCG.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is A, Intravesical BCG. High-grade non-muscle-invasive bladder cancer and carcinoma in situ carry a high risk of recurrence and progression.

Why is "External beam radiotherapy to the pelvis" not the answer?

Pelvic radiotherapy is not an established adjuvant for non-muscle-invasive bladder cancer.

Why is "Single-dose systemic cisplatin" not the answer?

Systemic cisplatin is used with muscle-invasive disease, not in pTa and carcinoma in situ.

Why is "Immediate radical cystectomy" not the answer?

Cystectomy is excessive for non-invasive disease that can be managed with BCG.

What concept does this question test?

It tests Urology: non-muscle-invasive bladder cancer in General Surgery. Intravesical BCG immunotherapy after complete resection reduces both and is the standard of care. Cystectomy is reserved for BCG failure, muscle invasion or very high-risk disease.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Urology: non-muscle-invasive bladder cancer?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.