Bladder cancer under staging: still unavoidable?

Under staging of locally advanced bladder urothelial cancer (BUC) is an important issue as far as it impacts the treatment and may hamper eventually the prognosis. It is particularly true for cT1 BUC as far as guidelines (1) provide also conservative treatment, which is indeed unfit to treat invasive cancer, leading to an impaired chance of surviving. Overall, under staging is not a rare phenomenon. It ranges up to 25% in specimen of second transurethral resection (2) and up to 50% in specimen of radical cystectomy (1,3) without significant improvement in the last decades.