[Clinical management of high-risk non-muscle-invasive bladder cancer during BCG shortage: what are the options, what are the risks?].

High-risk NMIBC is challenging since, although not being muscle-invasive, it is characterised by a high propensity for progression. It is important to determine the prognostic group, which should be done by means of nomograms. Following thorough transurethral resection, adjuvant therapy with BCG is a standard treatment, but BCG is partly unavailable at present due to shortage. Hyperthermic chemotherapy has also been studied, but its broad use is not yet justified based on the data currently available, which also holds true for checkpoint blockade inhibition. Therefore, given the high propensity for progression, early cystectomy is indicated in case of adverse tumour features.