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Treatment coverage includes intravesical therapy, immunotherapy, and gene therapy. The review highlights a shift toward precision, multimodal, biomarker-guided management and personalized adaptive surveillance using circulating and urinary tumor 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\n[https://doi.org/10.1080/20565623.2026.2622297](https://doi.org/10.1080/20565623.2026.2622297)  \nReview ARticle  \nDiagnosis, evaluation, and management of patients with non-muscle invasive bladder cancer  \nSri Saran Manivasagama, Amar Kassimb and Jay D Ramana  \naDepartment of urology, Penn State Health Milton S. Hershey Medical center, Hershey, PA, uSA; bPennsylvania State university college of Medicine, Hershey, PA, uSA  \nABSTRACT  \nIntroduction: Non-muscle invasive bladder cancer (NMiBc) accounts for over 75% of bladder cancer cases worldwide and is associated with high recurrence rates and significant surveillance costs. Advances in diagnostic modalities, risk stratification, and bladder-preserving therapies have transformed management strategies.  \nAreas Covered: this narrative review synthesizes evidence from 70 key publications identified through a comprehensive search of PubMed, MeDliNe, embase, Scopus, and Google Scholar (2005–2025). topics include clinical presentation, diagnostic innovations such as enhanced cystoscopy and urinary biomarkers, contemporary risk stratification models, and evolving treatment paradigms including intravesical therapy, immunotherapy, and gene therapy. Expert Opinion/Commentary: NMiBc management is shifting toward precision-based, multimodal approaches that integrate molecular biomarkers, immunotherapy, and novel drug delivery systems. while early-phase trials show promise, large-scale studies and real-world data are essential to validate these strategies. Personalized surveillance using circulating and urinary tumor DNA may reduce procedural burden and improve outcomes, marking a paradigm shift toward adaptive, patient-centered care.  \nARTICLE HIGHLIGHTS  \n• Over three-quarters of bladder cancers present as non-muscle invasive bladder cancer (NMiBc), a disease characterized by frequent recurrences and substantial long-term surveillance costs.  \n• Advances in diagnostic tools, particularly blue light cystoscopy and evolving urinary biomarker assays, enhance detection accuracy and lower recurrence rates compared with conventional white-light cystoscopy.  \n• Updated risk classification systems (AUA/SUO, eAU, and Ai-driven models such as PROGRxN-Bca) are improving estimation of recurrence and progression risk, enabling more individualized care.  \n• intravesical treatment remains central to NMiBc management, with BcG continuing as the primary therapy for high-risk disease; during BcG shortages, sequential chemotherapy and novel heat-based delivery systems serve as alternatives.  \n• emerging bladder-preserving therapies, including checkpoint inhibitors, gene-based therapeutics, and controlled-release intravesical platforms, demonstrate encouraging activity in patients with BcG-unresponsive disease.  \n• Novel molecular surveillance approaches (ctDNA, utDNA, and urine-derived biomarkers) are poised to shift follow-up toward adaptive, biomarker-guided protocols, potentially reducing procedural burden and improving patient-centered outcomes.  \n1. Introduction  \nARTICLE HISTORY  \nReceived 9 December 2025  \nAccepted 22 January 2026  \nKEYWORDS  \nNon-muscle invasive bladder cancer; diagnosis; risk stratification;  \nintravesical therapy; immunotherapy;  \nbiomarkers; surveillance; guidelines  \nBladder cancer (Bca) is the 12th most common cancer worldwide, with an estimated 573,000 new cases and 213,000 related deaths reported in 2020, highlighting its considerable burden on public health [1] . Globally, by 2040, the annual number of new Bca cases and deaths will increase to 991,000 (72.8% increase from 2020) and 397,000 (86 .6% increase from 2020) [2] . Bca is more common in males than females, with a ratio of approximately 5:1 [3] .  \nthe disease is characterized by marked heterogeneity in both clinical behavior and molecular profiles, with more than 75% of these cancers being staged as non-muscle invasive at initial presentation [4] . intravesical  \nCO","cbCaiolsb8werrMK","https://ap.wps.com/l/cbCaiolsb8werrMK","pdf",1288430,14,"English","# Introduction\n# Article Highlights\n# Diagnosis, Evaluation, and Management Overview\n## Diagnostic Innovations\n## Risk Stratification Models\n## Intravesical, Immunotherapy, and Gene-Based Treatments\n## Emerging Biomarker-Guided Surveillance","[{\"question\":\"Why is NMIBC considered a major clinical and public health challenge?\",\"answer\":\"NMIBC accounts for more than 75% of bladder cancer cases and is linked to frequent recurrences and significant long-term surveillance costs, creating a substantial burden on patients and healthcare systems.\"},{\"question\":\"Which diagnostic advancements are emphasized for NMIBC?\",\"answer\":\"Enhanced cystoscopy (including blue light cystoscopy) and urinary biomarker assays are highlighted as tools that can improve detection accuracy and reduce recurrence compared with conventional white-light cystoscopy.\"},{\"question\":\"How is NMIBC management evolving beyond standard intravesical therapy?\",\"answer\":\"Management is shifting toward precision-based, multimodal approaches that integrate molecular biomarkers, immunotherapy, and novel drug delivery systems, including emerging bladder-preserving therapies for BCG-unresponsive disease.\"}]","Diagnosis, evaluation, and management of patients with non-muscle invasive bladder cancer - Review Article | PDF",1790115607,35]