(UroToday.com) The 2026 European Association of Urology (EAU) annual meeting featured a surgical and non-surgical treatment of non muscle invasive bladder cancer session and a presentation by Dr. Christian Doehn discussing results from the VERSUS study assessing treatment of high grade non muscle invasive bladder cancer. Since May 2018, members of the German Uro-Oncologists (d-uo) have been documenting urological tumor diseases as part of the prospective VERSUS study. The objective of this study, presented at EAU 2026, was to investigate how patients with high grade non muscle invasive bladder are treated with intravesical instillation therapy. The VERSUS study by the d-uo group is a non-interventional, prospective, multicenter registry study for the documentation and descriptive statistical evaluation of diagnostics, treatment course, and follow-up care of uro-oncology patients in Germany. All patients with a urological tumor disease can be included in the VERSUS study.
From May 2018 to August 2025, 33,351 patients with a first diagnosis of urological cancer were documented. The following figure highlights the epidemiological differences between VERSUS (2018-2025) and all of Germany (2023):
Of these, 7,972 patients (24%) had bladder cancer. In terms of tumor stage, 79% of patients with bladder cancer were evaluable. Among patients with non muscle invasive bladder high grade (n = 2,128; high grade defined as G3 or high grade), 82% were men and 18% were women (median age 71 and 70 years, respectively). Stages TaHG, T1HG, and CIS alone were present in 40.4%, 49.7%, and 9.8% of patients, respectively. The type of intravesical therapy was known in 1,224 patients (57.5%). Overall, 70% of patients received BCG, and 30% received mitomycin C. In the TaHG tumor stage, 58% of patients received BCG and 42% received mitomycin C. In stage T1HG, 77% of patients received BCG, and 23.0% received mitomycin C. Patients with CIS alone received BCG in 88% of cases and mitomycin C in 12% of cases:
Of the patients treated with mitomycin C, 66% received a dose of 20 mg and 34% received a dose of 40 mg. A total of 87 urologists from d-uo were involved, who treated a median of 8 patients (range 1-150 patients) with the aforementioned stage of disease. Both therapies (BCG and mitomycin C) were used by 48 urologists (55%), BCG alone by 26 urologists (30%), and mitomycin C alone by 13 urologists (15%). Only mitomycin C 20 mg was used by 27 urologists (44%), only mitomycin C 40 mg (25%) by 15 urologists, and both dosages by 19 urologists (31%). Limitations of the study include the lack of therapy and outcome.
Dr. Doehn concluded this presentation discussing results from the VERSUS study with the following take-home points:
- Patients with high grade non muscle invasive bladder cancer receive BCG in only 7/10 cases
- The higher the risk (CIS > T1 > Ta), the more often BCG is used
- Grading data is missing in 25% of cases
- Mitomycin C 20 mg is used in 2/3 cases compared to mitomycin C 40 mg, with no clear trend by disease characteristics
- Urologists often use BCG (or mitomycin C) in all cases, and some mix therapies
- Ultimately, BCG is underused in high grade non muscle invasive bladder cancer in this real world practice in Germany
Presented by: Christian Doehn, Professor, Urologikum Lübeck, Lübeck, Germany
Written by: Zachary Klaassen, MD, MSc – Urologic Oncologist, Associate Professor of Urology, Georgia Cancer Center, Wellstar MCG Health, @zklaassen_md on Twitter during the 2026 European Association of Urology (EAU) Annual Meeting, London, United Kingdom, Fri, Mar 13 – Mon, Mar 16, 2026.