Question 1 of 5
(demo test)

Product Demo for Clinical

A 72 year old male presents to his primary care physician with hematuria. He is otherwise asymptomatic and his exam is within normal limits. A CT scan of the chest, abdomen and pelvis is ordered by his primary care physician, which demonstrates no evidence of disease. He is seen by urology and a urine cytology is non-diagnostic. An exam under anesthesia, cystoscopy, and transurethral resection of bladder tumor (TURBT) is performed. The procedure demonstrates a bladder tumor involving the posterior bladder wall and left trigone and pathology reveals a papillary urothelial carcinoma, high-grade, invading the lamina propria. However, detrusor muscle was not present in the specimen, and a repeat TURBT demonstrates urothelial carcinoma involving the detrussor muscle, consistent with clinical T2 disease. His work-up, including imaging of the upper urinary tract, is completed with no evidence of metastatic disease. His past medical history includes gastroesophageal reflux, hypertension, and diabetes mellitus type 2. He is a former smoker (~25 pack year history) and quit smoking 15 years ago. He does not drink alcohol and is a retired construction worker. His vitals are within normal limits and he has a very good performance status (ECOG 1). The patient is considered a good candidate for surgery, radiation, and chemotherapy. What treatment do you recommend for this patient?

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