Diagnosis, evaluation, and management of patients with non-muscle invasive bladder cancer

Introduction: 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. Areas 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.