Talking to Your Doctor About LG-IR-NMIBC Risk

Your bladder cancer risk group is one of the most useful things to know. Do you have low-grade intermediate-risk non-muscle invasive bladder cancer (LG-IR-NMIBC)? Knowing your group helps you take part in your care choices.¹

What risk groups mean in bladder cancer

Non-muscle invasive bladder cancer affects only the inner layers of the bladder. It has not reached the muscle wall. Doctors sort it into 3 risk groups: low, intermediate, and high.^1,2

Low-grade cancer cells look more like normal cells and tend to grow slowly.³

What makes low-grade cancer intermediate-risk

Doctors look at the number and size of your tumors and how often they return. Your low-grade cancer may be intermediate-risk if you have:^4,5

• Early return – The cancer came back within 1 year.
• More than 1 tumor – Doctors call this multifocal.
• A large tumor – A single tumor is bigger than 3 centimeters (a little over an inch).

Why knowing your risk group matters

Low-grade bladder cancer comes back (recurs) in nearly half of those who have it. But it rarely grows deeper into the muscle wall (progresses). Your risk group also shapes how often you need checkups and which treatment pathways are right for you.⁴

Experts say you and your doctor should decide together. It’s important to weigh results, side effects, cost, and your wishes.⁴

Questions to ask about your risk profile

If no one has told you your risk group, ask. Bring these questions to your next urology visit:

• “What specific criteria make my cancer intermediate-risk?”
• “What is my personal likelihood of recurrence versus progression?”
• “How does my risk classification narrow or expand my treatment choices?”

What surgical treatment may include

Transurethral resection of a bladder tumor (TURBT) is a surgery done through the tube that carries urine out of your body (urethra). You are usually asleep under general anesthesia. The surgeon passes a thin scope into the bladder and removes the tumor. Full recovery can take up to 6 weeks.⁶

If low-grade cancer keeps coming back, you may need multiple surgeries. Each one brings anesthesia risks, lost time, and cost.⁴

What non-surgical treatment may include

Mitomycin for intravesical solution (Zusduri®) is a non-surgical option. The US Food and Drug Administration (FDA) approved it in June 2025 for adults whose LG-IR-NMIBC has come back. It goes into your bladder through a thin tube (catheter) once a week for 6 weeks. The drug is a liquid when cold. It turns into a gel at body temperature. The gel helps the chemotherapy drug stay in the bladder longer.^5,7

In the main study, about 78 out of 100 people had no signs of cancer afterward. Of those, about 79 out of 100 stayed cancer-free for at least 12 months.⁷

Your doctor may also suggest BCG (TICE BCG®) after surgery. It uses your immune system to help keep cancer from coming back. Supply is limited, so it may be saved for certain people.^3,4,8

TICE BCG has a boxed warning, the strictest warning from the FDA. It has this warning because it contains live bacteria. These can cause serious and sometimes deadly infections.⁸

Possible side effects of each option

Side effects can vary depending on the specific treatment you are receiving. They may include:^5,6,8

• TURBT – Burning when you urinate, blood in your urine, infection, bleeding, or bladder injury.
• Zusduri® – Painful urination, urinary tract infection, blood in your urine, and changes in kidney and liver blood tests. Urine may turn violet-blue. It can harm an unborn baby. Birth control is needed during and after treatment.
• BCG – Painful or frequent urination, blood in your urine, fever, and flu-like symptoms.

These are not all the possible side effects of bladder cancer treatments. Talk to your doctor about what to expect with each treatment. You should also call your doctor if you notice any changes that concern you.

Questions to ask about treatment options

Before beginning treatment for bladder cancer, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you take. This includes over-the-counter drugs.

It may also be helpful to ask your doctor these questions about your treatment options:

• “Am I a candidate for non-surgical chemoablation?”
• “How does intravesical gel therapy work inside the bladder?”
• “What are the common side effects or recovery steps for each option?”

Life after treatment

For the first few years, your doctor may suggest a cystoscopy every 3 to 6 months. A doctor uses a thin scope to look inside your bladder. Over time, checkups may shift to once a year.³

Between visits, call your doctor if you notice:⁹

• Blood in your urine – Urine may look bright red or cola-colored.
• Urinating changes – Going more often or feeling pain.
• Back pain – Any back pain that worries you.

You are not alone

LG-IR-NMIBC often comes back, so it needs ongoing care. Knowing your risk group and talking openly with your care team can help you stay on track.