<p><strong> </strong><strong>At the time of each occurrence/recurrence, clinicians should assign a clinical stage and classify a patient accordingly as “low-,” “intermediate-,” or “high-risk.” (<em>Moderate Recommendation; Evidence Level: Grade C</em>)</strong></p>
Discussion
Discussion
<p>In creating the Guideline risk stratification system (see <strong>Table 3</strong>), the Panel chose to adhere to the general principles of the EORTC and CUETO models by including factors that have been found to have a significant impact on risk of recurrence and progression, such as tumor size, tumor focality, grade, and stage. In addition, the Panel incorporated evidence from other studies that has demonstrated that LVI, prostatic urethral involvement, and subtype histology also confer high-risk for progression to muscle invasion.<sup>86-90</sup></p>
<p>Risk stratification for each patient is a dynamic and iterative process. Patients may recur multiple times during the continuum of their care and may face repetitive therapeutic interventions, such as intravesical therapy. Those patients who recur following optimal standard intravesical therapy likely harbor more aggressive disease than implied by clinical or pathologic features; as such, continued risk evaluation and classification is necessary for the optimal care of patients prior to each treatment decision.</p>