(UroToday.com) At the American Urological Association (AUA)’s Drug Development in non-muscle-invasive bladder cancer (NMIBC) From Scientific, Regulatory, Clinician, and Patient Perspectives 2021 virtual meeting, Dr. Joaquim Bellmunt discussed ways to identify patients with high-risk NMIBC that should undergo immediate cystectomy. Dr. Bellmunt notes that the AUA guidelines suggest that a patient with high-grade T1 disease on repeat resection or T1 tumors with associate CIS, lymphovascular invasion, or variant histologies should be considered for an immediate radical cystectomy. These recommendations are echoed by the EAU Guidelines on NMIBC, suggesting that the highest risk tumors (ie. T1G3/HG + CIS, T1G3/HG + CIS in the prostatic urethra, multiple T1G3/HG lesions, T1G3/HG > 3cm, LVI, and variant histologies) should be considered for upfront cystectomy.